With many in the community supporting the idea of palliative care being an essential part of critical care, the integration of end-of-life support with curative and life-sustaining intervention is more crucial than ever.
Published in Critical Care Nurse (CCN), a recent report revealed that palliative care patients and their families face a variety of challenges when attempting to discuss care options with consultants who can properly advise.
Being able to provide patients with palliative care enables clinicians to package psychological, spiritual, goal-setting and decision-making support into a single service-based initiative designed to supply comfort.
Patients with life-threatening illnesses and their families can benefit from this kind of specialized care by taking advantage of early initiation of comfort-focused treatment goals, decreased length of stay, reduced costs of care without an increase in mortality and continuity of care.
The article, titled “Overcoming Barriers to Palliative Care Consultation,” outlines nursing-specific strategies on how hospitals can better integrate palliative care into everyday critical care. Additionally, it also encourages the widespread adoption of palliative care services.
The report noted that there are two main reasons (or barriers) for health care providers not offering consultations to patients who could potentially qualify for this specific type of end-of-life planning: misunderstandings about palliative care and not having agreed-upon criteria for referral.
“These strongly held beliefs and misperceptions prevent early integration for many patients and families who could benefit from palliative care,” said American Association of Critical-Care Nurses (AACN) President-elect Clareen Wiencek. “And yet, growing evidence shows that palliative care produces positive outcomes such as additional comfort, shorter ICU and hospital stays, avoidance of costs and increased satisfaction with communication in the healthcare environment.”
Current studies encourage nurses to lead the efforts of integrating palliative care into the care of the critically ill by identifying them as experts in this area. "Critical care nurses need to be involved in overcoming the barriers to palliative care consultation for their patients so that patients’ suffering is decreased and patient outcomes are enhanced," the study's authors wrote. "However, nurses also need to be involved because the nurses themselves experience high levels of stress related to end-of-life decision making."
“These calls to action come at the time when palliative care is maturing as a discipline,” Wiencek said during an interview. “Two levels of palliative care are now recognized: consultative and integrative.”
The former is better for the "complex patient and family situations that require consultation with a palliative care similar to consults with a neurology expert or a heart specialist," she noted.
Wiencek would like to see further research on the "impact of palliative care interventions started in the ICU on long-term patient and family outcomes."
"Evidence is needed about which patient and family centered outcomes are amenable to specific interventions as well as what interventions are likely to reduce the rising moral distress and burnout among critical care nurses and other ICU clinicians," she said. "Finally, research delineating the types of work environments that best support skillful communication and true collaboration between patients, families and care providers will inform members of the healthcare team about how best to create an environment where PC becomes a part of the everyday norm."
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