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

Objective. To identify perceived barriers, supports and changes needed to improve end-of-life care (EOLC) in the intensive care unit (ICU) and to compare physicians’ perceptions with those of nurses. Methods. We conducted a survey of critical care physicians and nurses in an academic medical center via a 3-item survey with open-ended statements regarding the strongest barriers, supports and changes needed to improve EOLC in ICU. Results. Thirty-four percent of all respondents identified physicians as the biggest barrier and thirty-three percent recognized nursing staff as the strongest support towards optimal EOLC. Improved communication was identified by 30% of respondents as the change most needed to improve EOLC. No significant differences between physicians and nurses were observed. Conclusions. Critical care physicians and nurses identified similar barriers, supports and the changes most needed to improve EOLC in the ICU. Recognition of physicians as the strongest barrier, and communication as the change most needed indicate areas for improvement. The finding of nurses as the strongest support for good EOLC provides the opportunity to strengthen their role in the care of the dying patient. Further study of these findings will help develop strategies to improve EOLC in the ICU.