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Feasibility and Acceptability of a Palliative Approach Screening Tool in the Intensive Care Unit
1Jane Venis was a staff nurse in the intensive care unit at St Paul's Hospital, Vancouver, and is now a nursing faculty instructor at British Columbia Institute of Technology, Burnaby, British Columbia, Canada. Peter Dodek is a professor at the Centre for Health Evaluation and Outcome Sciences and Division of Critical Care, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Insights
A new screening tool helps identify palliative care needs in intensive care units (ICUs). This tool is feasible, acceptable, and promotes earlier, broader discussions about patient and family needs.
Area of Science:
- Critical care medicine
- Palliative care
- Health services research
Background:
- Integrating palliative care into intensive care units (ICUs) requires identifying patients with unmet needs.
- The palliative approach aims to support patients and their families in critical care settings.
Purpose of the Study:
- To explore the integration of palliative care within an ICU.
- To develop and validate a screening tool to identify unmet palliative care needs.
Main Methods:
- A mixed-methods study was conducted in a tertiary care hospital ICU.
- Focus groups and surveys were used to develop the screening tool's items.
- Interviews and pilot testing refined the tool's content and operationalization.
Main Results:
- Focus groups highlighted communication issues and the need for better collaboration.
- Clinicians preferred screening items that identified specific needs over diagnoses.
- Pilot testing showed the tool prompted earlier and broader discussions about patient and family values.
Conclusions:
- A screening tool for unmet palliative care needs in ICUs is feasible and acceptable.
- The tool can systematically integrate the palliative approach into routine ICU care.
- This facilitates better support for critically ill patients and their families.
Background:
Identifying critically ill patients who have unmet needs for palliative care is the first step in integrating the palliative approach for patients and their families into intensive care units.
Objective:
To explore how palliative care is addressed in an intensive care unit and to develop and test a screening tool for unmet needs that may be met through the palliative approach.
Methods:
A mixed-methods study was conducted in the intensive care unit of a tertiary care hospital to explore the palliative approach. Focus groups and a survey were used to identify items for the screening tool. After pilot testing of the tool, interviews were conducted to refine the content.
Results:
The first focus group (14 participants) revealed participants' frustration with unclear communication and a desire for better collaboration among health care team members regarding patients with serious life-limiting illnesses and their families. The survey (response rate: 20%; 30 of 150) showed clinicians' preference for items that identify specific needs rather than diagnoses. The second focus group (8 participants) yielded strategies to operationalize the tool for all patients in the intensive care unit. After 2 separate pilot testing cycles, bedside nurses noted that use of the screening tool prompted earlier discussions and broader assessments of what is meaningful to patients and their families.
Conclusion:
Development of a screening tool for unmet palliative care needs among intensive care unit patients is feasible and acceptable and may help to systematically integrate the palliative approach into routine care for critically ill patients.
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