Intensive care unit (ICU) clinicians experience multiple barriers to quality end-of-life care conversations, a recent study found.1 Researchers interviewed 27 ICU clinicians and advanced practice providers at three hospitals. These themes were identified that either facilitated or obstructed end-of-life care:
• Work system barriers resulted in delays in end-of-life communication among the clinical team and between clinicians and families.
• Some clinicians overrelied on palliative care, viewing them as the only clinicians who could handle end-of-life discussions.
• End-of-life discussions varied greatly depending on which clinician was having the conversation. One ICU fellow stated, “The quality of the conversation depends very highly on who is having it. There’s no standardization.”
• Treatment goals of clinicians, family, and patients were misaligned. For example, clinicians might feel that the family should get a do-not-resuscitate order or withdraw care, but the family is not ready to do so. An advanced practice provider stated, “We could do a better job of supporting families when their decisions or goals do not align with our own.”
• Joint discussions between care teams led to fewer situations where conflicting information was provided to patients or families.
• Clinicians reported moral distress because of providing non-beneficial care.
An ICU attending stated, “There are circumstances when there’s real moral angst, moral anxiety amongst the ICU providers, because they feel like they’re doing things that are just unkind to patients.” An ICU fellow described a family that was pushing clinicians to do “everything,” which resulted in an ICU stay of several months. Throughout this, the patient was receiving care that clinicians perceived as harmful and inappropriate.
“It is important for clinicians to recognize that these are ethical dilemmas where ethicists can offer guidance,” says Anne Stey, MD, one of the study authors and an assistant professor of surgery at Northwestern Medicine.
REFERENCE
- Janczewski LM, Chandrasekaran A, Abahuje E, et al. Barriers and facilitators to end-of-life care delivery in ICUs: A qualitative study. Crit Care Med 2024; Feb 19. doi: 10.1097/CCM.0000000000006235. [Online ahead of print].
Intensive care unit clinicians experience multiple barriers to quality end-of-life care conversations, a recent study found.
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