Providing Palliative Care in the Medical ICU: A Qualitative Study of MICU Physicians' Beliefs and Practices.

Abstract

With the current and projected shortage of palliative care (PC) specialists, an integrative model of PC will be needed to meet the needs of patients in intensive care units (ICUs). Prior studies of PC interventions suggest that success depends upon meeting the needs of individual institutions or ICUs. The objective of this study was to qualitatively explore the beliefs and practices of one institution's medical ICU (MICU) physicians in regard to providing an integrative model of PC. This qualitative study used semistructured interviews of 17 physicians within a Department of Allergy, Pulmonary, and Critical Care Medicine at one large academic hospital. Interviews were conducted, transcribed, and coded according to qualitative research methods. Selected interviews were tested for interrater reliability and negotiated agreeability. All critical care physicians interviewed affirmed that providing PC was part of their job, and the majority expressed that providing PC gave them professional or personal satisfaction. Physicians also identified many ways that PC consultants enhance patient care in the MICU. They discussed several motivations for obtaining a PC consult, with the most frequently acknowledged motivation being lack of time. Developing an integrative model of PC in the ICU ought to take into account both studied interventions shown likely to be effective in the ICU setting and the specific needs and barriers to PC in that unit. This study demonstrates one way that needs and barriers can be identified and provides important findings that might be applicable to other institutions.