PMU102 PERCEPTIONS OF THE APPROPRIATENESS OF CARE IN ADULT INTENSIVE CARE UNITS AT A BRAZILIAN TERTIARY ACADEMIC MEDICAL CENTER

Abstract

Growing use of life-sustaining measures in patients with poor long-term expectation of survival concerns health practitioners with disproportionate care. Subsequent feelings of moral distress impact on quality of care of each new patient. Futile care also compromises allocation of scarce resources. We aimed to report prevalence of perceived inappropriate care among intensive care unit (ICU) staff physicians, training physicians, nurses and nursing auxiliaries in a public Brazilian hospital. Cross-sectional study of senior and junior doctors, nurses and nursing auxiliaries providing care to patients in the 34-bed multidisciplinary ICU of a tertiary teaching hospital in southern Brazil from January to July 2019. In total, 151 professionals completed an anonymous electronic survey. Response rate was 49.5%. One-hundred (66.2%) respondents had more than 10-year experience on the field. One-hundred eighteen (78.1%) professionals believed there were disproportionate care at ICU. Both nurses and nursing auxiliaries were less likely than doctors to receive training on communication of end-of-life information (10.6% vs 57.6%, p< 0.001). Twenty-nine (28.1%) nurses and nursing auxiliaries versus 4 (0.08%) doctors claimed there was no palliative care deliberations in ICU (p= 0.004). Death was perceived as a treatment failure by 10 (0.06%) health care providers. Thirty-two (48.5%) nursing auxiliaries versus 8 (21.6%) nurses and 6 (12.5%) physicians affirmed all available treatment should be provided to patients regardless of their chance of survival (p< 0.001). Sixty-seven (44.3%) participants believed patients' wishes for palliative care were generally not respected. Forty-three (89.5%) senior and junior doctors believed collaboration between physicians and nurses was good, whereas 58 (56.3%) nurses and nursing auxiliaries disagreed on that (p< 0.001). This was the first survey regarding perception of inappropriate care conducted in Latin America. Although a unicentric study, it represents the views of healthcare providers who work at a high complexity medical center in a public health system.