Understanding Staff Needs for Improving End-Of-Life Care in Critical Care Units: A Qualitative Focus Group Analysis and Service Evaluation.

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Objectives: Critical care is a place of frequent death, up to a quarter of those admitted die during admission. Caring for dying people provides many challenges, practically, professionally and personally. The aim of this study was to better understand the perspectives of staff caring for dying people in critical care and identify their priorities for improvement. Method: Three multidisciplinary focus groups of critical care staff at a large central London hospitals trust were facilitated with a semi structured format and digitally transcribed. Inductive thematic analysis was conducted to extract themes. Results: N = 34 (18 nursing, 7 allied health professionals, 6 medical, 3 clerical/administrative). The five themes were structured as priority statements: "We need to recognise" included the subthemes of being "sick enough to die" and potential rapid deteriorations in this setting; "We need to understand" with subthemes of perspectives on dying and prioritising time for conversations; "We need to connect" with subthemes of therapeutic relationship and physical presence; "We need to collaborate" with subthemes of critical care working and empowerment, and cross teams working; "We need support" with themes of experiencing support and making time to support others. Conclusion: We present an approach to identifying critical care departmental priorities for an end-of-life care improvement programme. The themes extracted will be used to evaluate systems for dying in critical care, aiming to empower staff to provide excellent care every time they look after a dying person. Relevance to Practice: This service evaluation identifies key priorities among critical care staff regarding end-of-life care. The insights can guide service improvements, such as tailored training and enhanced support for staff, to ensure better communication, collaboration, and quality care for patients at the end of life.