Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.

Publication ,  Journal Article
Wysham, NG; Hua, M; Hough, CL; Gundel, S; Docherty, SL; Jones, DM; Reagan, O; Goucher, H; Mcfarlin, J; Cox, CE
Published in: Crit Care Med
April 2017

OBJECTIVE: Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment. DESIGN: Mixed-methods study. SETTING: Medical and surgical ICUs at three large academic hospitals. PARTICIPANTS: Three hundred three nurses, intensivists, and advanced practice providers. MEASUREMENTS AND MAIN RESULTS: Clinicians completed written surveys that assessed attitudes about specialist palliative care presence and integration into the ICU setting, as well as acceptability of 23 published palliative care prompts (triggers) for specialist consultation. Most (n = 225; 75%) reported that palliative care consultation was underutilized. Prompting consideration of eligibility for specialist consultation by electronic health record searches for triggers was most preferred (n = 123; 41%); only 17 of them (6%) felt current processes were adequate. The most acceptable specialist triggers were metastatic malignancy, unrealistic goals of care, end of life decision making, and persistent organ failure. Advanced age, length of stay, and duration of life support were the least acceptable. Screening led by either specialists or ICU teams was equally preferred. Central themes derived from qualitative analysis of 65 written responses to open-ended items included concerns about the roles of physicians and nurses, implementation, and impact on ICU team-family relationships. CONCLUSIONS: Integration of palliative care specialists in the ICU is broadly acceptable and desired. However, the most commonly used current triggers for prompting specialist consultation were among the least well accepted, while more favorable triggers are difficult to abstract from electronic health record systems. There is also disagreement about the role of ICU nurses in palliative care delivery. These findings provide important guidance to the development of collaborative care models for the ICU setting.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

April 2017

Volume

45

Issue

4

Start / End Page

e372 / e378

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Specialization
  • Referral and Consultation
  • Quality Improvement
  • Physicians
  • Physician's Role
  • Palliative Care
  • Nurses
  • Nurse's Role
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wysham, N. G., Hua, M., Hough, C. L., Gundel, S., Docherty, S. L., Jones, D. M., … Cox, C. E. (2017). Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs. Crit Care Med, 45(4), e372–e378. https://doi.org/10.1097/CCM.0000000000002099
Wysham, Nicholas G., May Hua, Catherine L. Hough, Stephanie Gundel, Sharron L. Docherty, Derek M. Jones, Owen Reagan, Haley Goucher, Jessica Mcfarlin, and Christopher E. Cox. “Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.Crit Care Med 45, no. 4 (April 2017): e372–78. https://doi.org/10.1097/CCM.0000000000002099.
Wysham NG, Hua M, Hough CL, Gundel S, Docherty SL, Jones DM, et al. Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs. Crit Care Med. 2017 Apr;45(4):e372–8.
Wysham, Nicholas G., et al. “Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.Crit Care Med, vol. 45, no. 4, Apr. 2017, pp. e372–78. Pubmed, doi:10.1097/CCM.0000000000002099.
Wysham NG, Hua M, Hough CL, Gundel S, Docherty SL, Jones DM, Reagan O, Goucher H, Mcfarlin J, Cox CE. Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs. Crit Care Med. 2017 Apr;45(4):e372–e378.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

April 2017

Volume

45

Issue

4

Start / End Page

e372 / e378

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Specialization
  • Referral and Consultation
  • Quality Improvement
  • Physicians
  • Physician's Role
  • Palliative Care
  • Nurses
  • Nurse's Role