COMMENTARY

ICUs: Time to Overcome Resistance to Palliative Care Services

Betty R. Ferrell, PhD, RN

Disclosures

December 28, 2015

Barriers to Palliative Care Consultation

Perrin K, Kazanowski M
Crit Care Nurse. 2015;35:44-52

Study Summary

The benefits of palliative care in intensive care units (ICUs) are in sharp contrast to the often infrequent availability of this care. This article addresses the barriers to fully benefiting from palliative care for some of the sickest and most costly patients across ICUs in every hospital setting. The study identifies the most common barriers as well as actions to overcome these obstacles by critical care nurses, who, as the clinicians most often at the bedside, are key supports for patients and their family caregivers.

The key barriers, as identified in this study, are

  • Misunderstandings about palliative care;

  • Difficulty initiating a discussion about palliative care; and

  • Cultural issues.

With respect to misunderstanding, palliative care is still considered end-of-life care, and thus is often avoided. The use of triggers to identify those who could benefit from palliative care consultation is one key strategy to overcome this barrier.

The second area—the role of communication—is essential. The ICU setting involves difficult conversations from the time of admission and throughout the often uncertain course of care for critically ill patients. Nurses play an important role in facilitating patient and family conferences, advocating for palliative care consultation, and participating with physicians in communication of information related to treatment options.

The third area is cultural issues. The culture of the ICU is often characterized as being in sharp contrast to many fundamental aspects of palliative care. Culturally based values and beliefs can be in sharp contrast to the ICU culture. Inclusion of palliative care nurses in ICU rounds and creating processes to assess and respond to cultural issues is vital. Assessment of cultural factors in patients and families is the first step.

Viewpoint

The latest statistics from the Center to Advance Palliative Care report that 90% of hospitals with 300 or more beds have palliative care.[1] With such widespread accessibility, it is of great interest to see statistics indicating continuing needs in ICU settings. Numerous studies continue to document futile care in ICUs, prolonged ICU stays, low rates of advanced directive completion or family conferencing, and uncontrolled pain and symptoms in these patients.[2,3,4,5]

The ICU will continue to be a major area of opportunity for integration of palliative care. Overcoming these barriers will require interdisciplinary collaboration, culture change, and improved communication.[6]

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