Palliative Care in the ICU: A Qualitative Study of MICU Physicians’ Beliefs & Practices (S702)

Abstract

•Delineate the models by which palliative care (PC) may be provided for medical ICU (MICU) patients.•Describe services provided by PC physicians that critical care (CC) physicians find particularly helpful.•Appreciate that many CC physicians gain satisfaction from providing PC for their patients, and so understand the value of educating and supporting CC physicians in providing PC. Despite the recent growth of palliative care (PC) as a specialty, there remains a relative shortage of PC professionals. In medical intensive care units (MICUs) both PC and critical care (CC) physicians are needed to meet the need for PC. We aimed to explore MICU physicians’ beliefs and practices regarding PC. This analysis reports MICU physician’s beliefs about providing PC, the role that they attribute to the PC team, and their motivations for initiating a PC consultation. Seventeen of the 53 physicians within a Department of Allergy, Pulmonary, and Critical Care Medicine took part in semi-structured interviews, which were conducted, transcribed and coded according to qualitative research methods. Four code-rich interviews were tested for inter-rater reliability, and 96% agreeability was reached through negotiated agreement. All CC physician participants stated that PC was a part of their job, and 9 out of 17 expressed gaining professional identity or personal satisfaction from providing PC. Participants identified many activities performed by PC consultants that were helpful to the CC team. They also described a variety of motivations for seeking a consult, some of which were unrelated to the specific expertise of a PC clinician. This study provides a baseline understanding of the PC provided by MICU physicians and when a PC consulting team may be most helpful in one academic medical center. It also provides support for developing an appropriate balance of primary and secondary palliative care, as it is likely to support physicians’ job satisfaction as well as optimal patient care.