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Crit Care Med. 2006 Oct;34(10):2547-53.

End-of-life care for the critically ill: A national intensive care unit survey.

Author information

  • 1Department of Medicine, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, NY 10029, USA. judith.nelson@mountsinai.org

Abstract

OBJECTIVE:

One in five Americans dies following treatment in an intensive care unit (ICU), and evidence indicates the need to improve end-of-life care for ICU patients. We conducted this study to elicit the views and experiences of ICU directors regarding barriers to optimal end-of-life care and to identify the type, availability, and perceived benefit of specific strategies that may improve this care.

DESIGN:

Self-administered mail survey.

SETTING:

Six hundred intensive care units.

PARTICIPANTS:

A random, nationally representative sample of nursing and physician directors of 600 adult ICUs in the United States.

INTERVENTIONS:

Mail survey.

MEASUREMENTS AND MAIN RESULTS:

We asked participants about barriers to end-of-life care (1 = huge to 5 = not at all a barrier), perceived benefit of strategies to improve end-of-life care, and availability of these strategies. From 468 ICUs (78.0% of sample), 590 ICU directors participated (406 nurses [65.1% response] and 184 physicians [31.7% response]). Respondents had a mean of 16.6 yrs (sd 7.6 yrs) of ICU experience. Important barriers to better end-of-life care included patient/family factors, including unrealistic patient/family expectations 2.5 (1.0), inability of patients to participate in discussions 2.7 (0.9), and lack of advance directives 2.9 (1.0); clinician factors, which included insufficient physician training in communication 2.9 (1.1) and competing demands on physicians' time 3.0 (1.1); and institution/ICU factors, such as suboptimal space for family meetings 3.5 (1.2) and lack of a palliative care service 3.4 (1.2). More than 80% of respondents rated 14 of 14 strategies as likely to improve end-of-life care, including trainee role modeling by experienced clinicians, clinician training in communication and symptom management, regular meetings of senior clinicians with families, bereavement programs, and end-of-life care quality monitoring. However, few of these strategies were widely available.

CONCLUSIONS:

Intensive care unit directors perceive important barriers to optimal end-of-life care but also universally endorse many practical strategies for quality improvement.

Comment in

PMID:
16932230
[PubMed - indexed for MEDLINE]
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