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Am J Hosp Palliat Care. 2020 Feb;37(2):108-116. doi: 10.1177/1049909119867658. Epub 2019 Aug 15.

Survey on Barriers to Critical Care and Palliative Care Integration.

Author information

1
Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
2
Institut du Savoir Montfort, Ottawa, Ontario, Canada.
3
The Ottawa Hospital-General Campus, Ottawa, Ontario, Canada.
4
The Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada.
5
Faculty of Social Sciences, School of Psychology, University of Ottawa, Ontario, Canada.
6
Faculty of Health Sciences, School of Nursing, University of Ottawa, Ontario, Canada.
7
Division of Critical Care Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada.
8
Hôpital Montfort, Ottawa, Ontario, Canada.

Abstract

PURPOSE:

It has been shown that integrating palliative care (PC) in intensive care unit (ICU) improves end-of-life care (EOLC), but very few Canadian hospitals have adopted this practice. Our study aims to evaluate the perceived quality of EOLC at participating institutions and explore barriers toward ICU-PC integration.

MATERIALS AND METHODS:

A self-administered questionnaire was developed by a multidisciplinary team. Survey items were extracted from published quality indicators in EOLC and barriers to ICU-PC integration. The study took place at 2 academic institutions. Participants consisted of physicians and nurses, ICU administrators, and allied health workers.

RESULTS:

An overall response of 45% was achieved. Of total, 85% of the respondents were ICU nurses. The following main themes were identified: (1) There is a poor presence of PC in the ICU and 78% of respondents felt that increasing ICU-PC integration will improve quality of EOLC; (2) the main barrier to integration was unrealistic patient and/or family expectations; and (3) criteria-triggered consultation to PC was the most feasible way to achieve integration.

CONCLUSION:

Our findings indicate that the majority of respondents perceive that the presence of PC in ICU will improve EOLC. Future quality improvement initiatives can focus on developing a set of criteria for triggering PC consults.

KEYWORDS:

critical care; palliative care; quality improvement; terminal care

PMID:
31416329
DOI:
10.1177/1049909119867658

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