Article Text

Download PDFPDF
Palliative care integration in the intensive care unit: healthcare professionals’ perspectives – a qualitative study
  1. Choo Hwee Poi1,2,
  2. Hwee Sing Khoo3,
  3. Shih-Ling Ang1,2,
  4. Mervyn Yong Hwang Koh1,2 and
  5. Allyn Yin Mei Hum1,2
  1. 1Palliative Medicine, Tan Tock Seng Hospital, Singapore
  2. 2Palliative Care Centre for Excellence in Research and Education, Singapore
  3. 3Health Outcomes and Medical Education Research (HOMER), National Healthcare Group, Singapore
  1. Correspondence to Dr Choo Hwee Poi, Palliative Medicine, Tan Tock Seng Hospital, 308433, Singapore; choo_hwee_poi{at}ttsh.com.sg

Abstract

Objectives The complex care needs and high mortality of critically ill patients in intensive care unit (ICU) warrants a team approach. While studies have affirmed the integral role of palliative care teams in ICU, little is known about the ICU healthcare professional’s perception on how this integration affects the care of the critically ill.

This study examines their perception of how integration of palliative care into ICU practice affects interprofessional collaborative practices and relationships in the delivery of care.

Methods A qualitative study was conducted in 13 focus group discussions with 54 ICU healthcare professionals recruited through purposive sampling. Data were analysed using a qualitative descriptive approach reflecting uninterpreted participants’ description of their experiences in its most unbiased manner.

Results ICU clinicians perceived that palliative care integration into the ICU enhanced care of patients and team dynamics in three areas: (1) bridging care, (2) cultural shift and (3) empowering, advocating and enhancing job satisfaction. Enhanced collaborative efforts between disciplines led to improved mutual understanding, shared-decision making and alignment of care goals. There was a shift in perception of dying as a passive process, to an active process of care where various healthcare professionals could work together to optimise symptom control and support grieving families. Team members felt empowered to advocate for patients, improving their sense of job fulfilment.

Conclusions Palliative care integration enhanced perception of collaborative practices in caring for the dying. Future studies could use empirical methods to measure collaboration and patient outcomes to further understand team dynamics.

  • Quality of life
  • Terminal care
  • Communication

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. The data included as online supplemental information can be published.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. The data included as online supplemental information can be published.

View Full Text

Footnotes

  • Contributors CHP is the guarantor of the study and also contributed in the following: (1) Design of the research work and analysis of data, (2) Drafted the article and revised it critically for publication. HSK contributed in the following: (1) Drafted the article and revised it critically for publication. S-LA (1) Analysis of the data and (2) Revised the article critically for publication. MYHK contributed in the following: (1) Revised the article critically for publication, (2) Approved the version to be published. AH contributed in the following: (1) Design of the research work and analysis of data, (2) Revised the article critically for publication and (3) Approved the version to be published.

  • Funding This work was supported by the National Healthcare Group, Health Outcomes and Medical Education Research (NHG-HOMER), Singapore. The grant number is NHG-HOMER FY16/B01.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.