End-of-life care in the intensive care unit: the perceived barriers, supports, and changes needed

Emir Festic, Reetu Grewal, Jeffrey T. Rabatin, Gavin D. Divertie, Robert P. Shannon, Margaret M. Johnson


Objective. To identify perceived barriers, supports andchanges needed to improve end-of-life care (EOLC) in theintensive care unit (ICU) and to compare physicians’ perceptionswith those of nurses. Methods. We conducted a surveyof critical care physicians and nurses in an academic medicalcenter via a 3-item survey with open-ended statements regardingthe strongest barriers, supports and changes neededto improve EOLC in ICU. Results. Thirty-four percent of allrespondents identified physicians as the biggest barrier andthirty-three percent recognized nursing staff as the strongestsupport towards optimal EOLC. Improved communicationwas identified by 30% of respondents as the change mostneeded to improve EOLC. No significant differences betweenphysicians and nurses were observed. Conclusions. Criticalcare physicians and nurses identified similar barriers, supportsand the changes most needed to improve EOLC in the ICU.Recognition of physicians as the strongest barrier, and communicationas the change most needed indicate areas for improvement.The finding of nurses as the strongest support for goodEOLC provides the opportunity to strengthen their role in thecare of the dying patient. Further study of these findings willhelp develop strategies to improve EOLC in the ICU.


End-of-life care; Intensive care unit; Physicians; Nurses

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