ICU sedation, delirium & recovery
Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study
Authors' conclusion
Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.
Study context
- Population
- Frontline ICU clinicians (critical care and palliative care physicians, advanced practice providers, nurses, social workers, chaplains) in seven ICUs across three hospitals of an integrated academic health system
- Participants
- 27 semi-structured interviews
- Outcome
- Themes: barriers or facilitators to end-of-life care
Methodological detailssemi-structured interviews, thematic analysis, multicentre
- Semi-structured interviews
- Thematic analysis
- Multicentre
Main finding
As reported in the abstract
- Work system barriers delayed end-of-life care communication among clinicians and between clinicians and families (e.g. over-reliance on palliative care people prevented timely discussions with families)
- Clinician-level variability in end-of-life communication tasks; discussions varied greatly in process and outcomes depending on the clinician leading
- Clinician-family-patient priorities or treatment goals misaligned; regular discussion and joint decisions facilitated higher familial confidence and fewer conflicting messages
- Clinician moral distress from providing nonbeneficial care
- 4 themes
Observational data: associations, not effects.
Further findings
Standardized end-of-life care discussion process
- Interviewees reported a standardized discussion process involving patient, family and clinicians was foundational to reducing patient and family suffering and clinician moral distress
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study. Crit Care Med. Published 19 February 2024. doi:10.
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