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

doi:10.1089/jpm.2023.0034

. 2023 Dec;26(12):1644-1653.

doi: 10.1089/jpm.2023.0034. Epub 2023 Oct 13.

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

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
DOI: 10.1089/jpm.2023.0034

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

Tammy L Eaton et al. J Palliat Med. 2023 Dec.

. 2023 Dec;26(12):1644-1653.

doi: 10.1089/jpm.2023.0034. Epub 2023 Oct 13.

Authors

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
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.

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Conflict of interest statement

No conflicts of interest declared by the authors. This does not necessarily represent the views of the U.S. government or the Department of Veterans Affairs.

Figures

**FIG. 1.**
Clinician-reported facilitators to palliative care delivery in the post-ICU clinic setting. CFIR, Consolidated Framework for Implementation Research; ICU, intensive care unit.

**FIG. 2.**
Clinician-reported barriers to palliative care delivery in the post-ICU clinic setting.

See this image and copyright information in PMC

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References

1. Sevin CM, Bloom SL, Jackson JC, et al. . Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center. J Crit Care 2018;46:141–148; doi: 10.1016/j.jcrc.2018.02.011. - DOI - PMC - PubMed
1. Bakhru RN, Davidson JF, Bookstaver RE, et al. . Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center. Crit Care Explor 2019;1(8):e0034; doi: 10.1097/cce.0000000000000034. - DOI - PMC - PubMed
1. Butcher BW, Eaton TL, Montgomery-Yates AA, Sevin CM. Meeting the challenges of establishing intensive care unit follow-up clinics. Am J Crit Care 2022;31(4):324–328. - PubMed
1. Danesh V, Boehm LM, Eaton TL, et al. . Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems. Crit Care Explor 2022;4(3):e0658; doi: 10.1097/cce.0000000000000658. - DOI - PMC - PubMed
1. Haines KJ, McPeake J, Hibbert E, et al. . Enablers and barriers to implementing ICU follow-up clinics and peer support groups following critical illness: The thrive collaboratives. Crit Care Med 2019;47(9):1194–1200; doi: 10.1097/ccm.0000000000003818. - DOI - PMC - PubMed

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[1] Sevin CM, Bloom SL, Jackson JC, et al. . Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center. J Crit Care 2018;46:141–148; doi: 10.1016/j.jcrc.2018.02.011. - DOI - PMC - PubMed

[2] Sevin CM, Bloom SL, Jackson JC, et al. . Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center. J Crit Care 2018;46:141–148; doi: 10.1016/j.jcrc.2018.02.011. - DOI - PMC - PubMed

[3] Bakhru RN, Davidson JF, Bookstaver RE, et al. . Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center. Crit Care Explor 2019;1(8):e0034; doi: 10.1097/cce.0000000000000034. - DOI - PMC - PubMed

[4] Bakhru RN, Davidson JF, Bookstaver RE, et al. . Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center. Crit Care Explor 2019;1(8):e0034; doi: 10.1097/cce.0000000000000034. - DOI - PMC - PubMed

[5] Butcher BW, Eaton TL, Montgomery-Yates AA, Sevin CM. Meeting the challenges of establishing intensive care unit follow-up clinics. Am J Crit Care 2022;31(4):324–328. - PubMed

[6] Butcher BW, Eaton TL, Montgomery-Yates AA, Sevin CM. Meeting the challenges of establishing intensive care unit follow-up clinics. Am J Crit Care 2022;31(4):324–328. - PubMed

[7] Danesh V, Boehm LM, Eaton TL, et al. . Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems. Crit Care Explor 2022;4(3):e0658; doi: 10.1097/cce.0000000000000658. - DOI - PMC - PubMed

[8] Danesh V, Boehm LM, Eaton TL, et al. . Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems. Crit Care Explor 2022;4(3):e0658; doi: 10.1097/cce.0000000000000658. - DOI - PMC - PubMed

[9] Haines KJ, McPeake J, Hibbert E, et al. . Enablers and barriers to implementing ICU follow-up clinics and peer support groups following critical illness: The thrive collaboratives. Crit Care Med 2019;47(9):1194–1200; doi: 10.1097/ccm.0000000000003818. - DOI - PMC - PubMed

[10] Haines KJ, McPeake J, Hibbert E, et al. . Enablers and barriers to implementing ICU follow-up clinics and peer support groups following critical illness: The thrive collaboratives. Crit Care Med 2019;47(9):1194–1200; doi: 10.1097/ccm.0000000000003818. - DOI - PMC - PubMed

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

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

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