86 Caring for dying patients in critical care settings: survey of palliative care and critical care practices and perspectives

Abstract

<h3>Background</h3> A significant proportion of hospital deaths occur in critical care settings, many have palliative care needs. Palliative care involvement is variable, and little is known about the differing perspectives and practices of palliative care (PC) and critical care (CC) professionals in caring for dying patients in this setting. <h3>Methods</h3> This was an electronic survey developed as part of a regional guideline development process. It was distributed across North-West England via service leads for critical care and palliative care, with all professionals involved in the care of patients dying in critical care settings invited to participate February-March 2019. <h3>Results</h3> 36 professionals from a PC background (30 providing face-to-face reviews and 6 telephone advice only) and 31 from a CC background completed the survey. Confidence in prescribing medication for common symptoms was high in both CC professionals and PC professionals providing face-to-face reviews. CC professionals reported a preference for the intravenous route for both as required (68% of respondents) and continuous infusions (58%) of symptom control medication, whilst PC professionals preferred the subcutaneous route (79% and 83% respectively). The most common reason CC professionals reported referring to palliative care was rapid discharge of dying patients (84% of respondents), whereas the most common area PC professionals reported assisting with was symptom control, both during face to face reviews (100%) and telephone advice (94%). Priorities for further education included symptom control medication (both groups), withdrawal of ventilation (PC professionals) and preparing families (CC professionals). <h3>Conclusions</h3> Palliative care and critical care professionals report differing practices in symptom management for dying patients on critical care and differing perspectives of the role of palliative care in this setting. Understanding these practices and perspectives is valuable in developing guidelines for the management of dying patients in critical care units and identifying areas for increased education and support.