Palliative Care in Survivors of Critical Illness: A Qualitative Study of Post-Intensive Care Unit Program Clinicians

Tammy L Eaton; Taylor E Lincoln; Anna Lewis; Brian C Davis; Carla M Sevin; Thomas S Valley; Heidi S Donovan; Jennifer Seaman; Theodore J Iwashyna; Sheila Alexander; Leslie P Scheunemann

doi:10.1089/jpm.2023.0034

Palliative Care in Survivors of Critical Illness: A Qualitative Study of Post-Intensive Care Unit Program Clinicians

J Palliat Med. 2023 Dec;26(12):1644-1653. doi: 10.1089/jpm.2023.0034. Epub 2023 Oct 13.

Authors

Tammy L Eaton^{1

2

3}, Taylor E Lincoln^{4

5}, Anna Lewis^{6

7}, Brian C Davis⁸, Carla M Sevin⁹, Thomas S Valley^{10

11

12

13}, Heidi S Donovan^{14

15}, Jennifer Seaman³, Theodore J Iwashyna^{16

17}, Sheila Alexander^{3

4}, Leslie P Scheunemann^{18

19}

Affiliations

¹ National Clinician Scholars Program (NCSP), VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor, Michigan, USA.
² Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
³ Department of Acute and Tertiary Care, and School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴ Department of Critical Care Medicine, and Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁵ Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁶ Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁷ Department of Clinical Care Coordination and Discharge Planning, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA.
⁸ Kline School of Law, Duquesne University, Pittsburgh, Pennsylvania, USA.
⁹ Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁰ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹¹ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
¹² VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.
¹³ Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁵ Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁶ Department of Medicine, Division of Pulmonary and Critical Care, School of Public Health, Baltimore, Maryland, USA.
¹⁷ Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁸ Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

PMID: 37831930
PMCID: PMC10771886 (available on 2024-12-01)
DOI: 10.1089/jpm.2023.0034

Abstract

Background: Survivors of critical illness experience high rates of serious health-related suffering. The delivery of palliative care may assist in decreasing this burden for survivors and their families. Objectives: To understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. Design: Qualitative inquiry using semistructured interviews and framework analysis. Results were mapped using the Consolidated Framework for Implementation Research. Setting/Subjects: We interviewed 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. Results: All interprofessional clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. Facilitators promoting palliative care strategies were clinician level, including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers were reciprocals and included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers included time constraints, cost, and lack of specialty palliative care services. Conclusion: Palliative care may be an essential element of post-ICU clinic care. Implementation efforts focused on tailoring strategies to improve post-ICU program clinicians' palliative care knowledge and self-efficacy could be a key to enhanced care delivery for survivors of critical illness.

Keywords: CFIR; ICU survivor; critical illness survivorship; palliative care; post-ICU clinic; qualitative research.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Critical Care
Critical Illness*
Humans
Intensive Care Units
Palliative Care* / methods
Qualitative Research
Survivors
United States

Abstract

Publication types

MeSH terms

Grants and funding