End-of-life care for the critically ill: A national intensive care unit survey. Export

@article{citeulike:1220577, abstract = {OBJECTIVE: One in five Americans dies following treatment in an intensive care unit (ICU), and evidence indicates the need to improve end-of-life care for ICU patients. We conducted this study to elicit the views and experiences of ICU directors regarding barriers to optimal end-of-life care and to identify the type, availability, and perceived benefit of specific strategies that may improve this care. DESIGN: Self-administered mail survey. SETTING: Six hundred intensive care units. PARTICIPANTS: A random, nationally representative sample of nursing and physician directors of 600 adult ICUs in the United States. INTERVENTIONS: Mail survey. MEASUREMENTS AND MAIN RESULTS: We asked participants about barriers to end-of-life care (1 = huge to 5 = not at all a barrier), perceived benefit of strategies to improve end-of-life care, and availability of these strategies. From 468 ICUs (78.0\% of sample), 590 ICU directors participated (406 nurses [65.1\% response] and 184 physicians [31.7\% response]). Respondents had a mean of 16.6 yrs (sd 7.6 yrs) of ICU experience. Important barriers to better end-of-life care included patient/family factors, including unrealistic patient/family expectations 2.5 (1.0), inability of patients to participate in discussions 2.7 (0.9), and lack of advance directives 2.9 (1.0); clinician factors, which included insufficient physician training in communication 2.9 (1.1) and competing demands on physicians' time 3.0 (1.1); and institution/ICU factors, such as suboptimal space for family meetings 3.5 (1.2) and lack of a palliative care service 3.4 (1.2). More than 80\% of respondents rated 14 of 14 strategies as likely to improve end-of-life care, including trainee role modeling by experienced clinicians, clinician training in communication and symptom management, regular meetings of senior clinicians with families, bereavement programs, and end-of-life care quality monitoring. However, few of these strategies were widely available. CONCLUSIONS: Intensive care unit directors perceive important barriers to optimal end-of-life care but also universally endorse many practical strategies for quality improvement.}, address = {Department of Medicine, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, NY 10029, USA. judith.nelson@mountsinai.org}, author = {Nelson, J. E. and Angus, D. C. and Weissfeld, L. A. and Puntillo, K. A. and Danis, M. and Deal, D. and Levy, M. M. and Cook, D. J. and {}}, citeulike-article-id = {1220577}, citeulike-linkout-0 = {http://dx.doi.org/10.1097/01.CCM.0000239233.63425.1D}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16932230}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16932230}, doi = {10.1097/01.CCM.0000239233.63425.1D}, issn = {0090-3493}, journal = {Crit Care Med}, keywords = {end-of-life-decisions, physician}, month = {October}, number = {10}, pages = {2547--2553}, posted-at = {2007-04-11 13:59:24}, priority = {0}, title = {End-of-life care for the critically ill: A national intensive care unit survey.}, url = {http://dx.doi.org/10.1097/01.CCM.0000239233.63425.1D}, volume = {34}, year = {2006} }

TY - JOUR ID - citeulike:1220577 L3 - citeulike-article-id:1220577 N2 - OBJECTIVE: One in five Americans dies following treatment in an intensive care unit (ICU), and evidence indicates the need to improve end-of-life care for ICU patients. We conducted this study to elicit the views and experiences of ICU directors regarding barriers to optimal end-of-life care and to identify the type, availability, and perceived benefit of specific strategies that may improve this care. DESIGN: Self-administered mail survey. SETTING: Six hundred intensive care units. PARTICIPANTS: A random, nationally representative sample of nursing and physician directors of 600 adult ICUs in the United States. INTERVENTIONS: Mail survey. MEASUREMENTS AND MAIN RESULTS: We asked participants about barriers to end-of-life care (1 = huge to 5 = not at all a barrier), perceived benefit of strategies to improve end-of-life care, and availability of these strategies. From 468 ICUs (78.0% of sample), 590 ICU directors participated (406 nurses [65.1% response] and 184 physicians [31.7% response]). Respondents had a mean of 16.6 yrs (sd 7.6 yrs) of ICU experience. Important barriers to better end-of-life care included patient/family factors, including unrealistic patient/family expectations 2.5 (1.0), inability of patients to participate in discussions 2.7 (0.9), and lack of advance directives 2.9 (1.0); clinician factors, which included insufficient physician training in communication 2.9 (1.1) and competing demands on physicians' time 3.0 (1.1); and institution/ICU factors, such as suboptimal space for family meetings 3.5 (1.2) and lack of a palliative care service 3.4 (1.2). More than 80% of respondents rated 14 of 14 strategies as likely to improve end-of-life care, including trainee role modeling by experienced clinicians, clinician training in communication and symptom management, regular meetings of senior clinicians with families, bereavement programs, and end-of-life care quality monitoring. However, few of these strategies were widely available. CONCLUSIONS: Intensive care unit directors perceive important barriers to optimal end-of-life care but also universally endorse many practical strategies for quality improvement. IS - 10 JF - Crit Care Med SN - 0090-3493 AD - Department of Medicine, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, NY 10029, USA. judith.nelson@mountsinai.org EP - 2553 TI - End-of-life care for the critically ill: A national intensive care unit survey. VL - 34 SP - 2547 KW - end-of-life-decisions KW - physician AU - Nelson, JE AU - Angus, DC AU - Weissfeld, LA AU - Puntillo, KA AU - Danis, M AU - Deal, D AU - Levy, MM AU - Cook, DJ PY - 2006/10// UR - http://dx.doi.org/10.1097/01.CCM.0000239233.63425.1D ER -