Assessing the Housestaff Knowledge, Attitudes, and Perceived Barriers Towards Palliative Care in the ICU

Abstract

PURPOSE: Palliative care (PC) and end-of-life (EOL) care are important in the management of critically ill patients. It provides a better patient care and is a key quality measure in the ICU. House staff form a significant work force in the ICU and most often are the only group that provide round the clock coverage. To provide effective care the house staff should be competent. Our study aims at assessing house staff's knowledge, attitudes and identifying barriers perceived by them while delivering PC-EOL care in the ICU. METHODS: The study is cross-sectional, conducted at St Louis University Hospital. Electronic surveys were sent via email to house staff (residents). Survey responses were confidentially collected and analyzed. RESULTS: Out of the 30 respondents, only 23 (77%) reported to have ever received any training in palliative care. Didactic lectures were the most common form of PC training and only 7 % took an elective rotation for training. 41 % would consider PC only when a patient is either terminally ill or rapidly deteriorating. About 93 % identified that knowledge and skills in delivering PC are important. However, only 53% were comfortable in delivering PC, EOL care in ICU. The most commonly identified barriers included: 1) discrepancies in treatment goals between medical team and families, 2) lack of advance directives at hospital admission, 3) uncertainties in prognosis, 4) effective communication with families and 5) a protocol for managing PC patients. CONCLUSIONS: PC and EOL care training is not routinely offered to all the house staff working in the ICU's. Even though didactic lectures are the most common form of training, it doesn't completely prepare the house staff to confidently and effectively deliver care. The most common perceived barriers should be addressed to help the house staff take care of PC and EOL care patients.