Research paperBarriers, enablers and challenges to initiating end-of-life care in an Australian intensive care unit context
Section snippets
Background and literature review
Patients admitted to Australian intensive care units (ICUs) are critically unwell and present challenges related to increased mortality. Several ICU patients require withdrawal of active treatment and commencement of end-of-life (EOL) care.1, 2 To provide optimal EOL care ICU clinicians must be sufficiently prepared and supported by healthcare organisations.3 Many barriers exist in transitioning patients to EOL care, including a lack of education and limited emotional and organisational support
Aims
The aim of the study was to explore the experiences and perspectives of physicians and nurses when providing EOL care in the ICU. The study addressed the following research question: What are the barriers, enablers and challenges that clinicians encounter when initiating and delivering EOL care within the ICU? An enabler is defined as something that enables achievement of an end point. A challenge is a problem or difficulty associated with initiating and delivering EOL care, whereas a barrier
Methods
An interpretative, qualitative inquiry framework was employed. Focus groups were conducted, with a semi-structured format. A focus group approach was used as it was perceived that deep reflections and discussion among clinicians who provided EOL care in ICU would be encouraged. This study was granted ethics approval by the participating health service.
Results
Five focus groups were conducted, two involving physicians and three involving nurses. Eleven physicians and seventeen nurses participated in the study. Table 2, Table 3 present a summary of the demographic and qualification characteristics of participating physicians and nurses. Quotes from transcripts have been used to support the themes relating to barriers, enablers and challenges. These quotes have been coded using the nomenclature of PG and NG to indicate physician group and nursing group
Discussion
This study shows there is a gap in the current education delivered to nurses and physicians in communicating with patients and their families at EOL. There was a lack of education and training opportunities for clinicians identified in this study. The ANZICS Statement on Care and Decision-Making at the EOL for the Critically Ill (2014) recommends that ICU staff involved with dying patients should undertake education in how to communicate effectively with patients and their families around EOL
Conclusion
Insights from this study contribute to a growing body of Australian literature on EOL care. The results will assist in improving multidisciplinary EOL care practices in the ICU. A major recommendation is to develop a structured education program, individually tailored to nurses and physicians, so all clinicians who engage in EOL care discussions are adequately prepared. Despite communication education being one of the recommendations of the ANZICS Statement on Care and Decision-Making at the
Authors’ contributions
All authors have made substantial contributions to all of the following: (1) the conception of the work; the interpretation of data for the work, drafting the article and revising it critically for important intellectual content, final approval of the version to be submitted, and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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