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Opportunities for Palliative Care in Long-Term Acute Care: A Concurrent Mixed-Methods Study
Katherine H Walker1, Valencia Lambert2, Annie Liu3
1Dana-Farber Cancer Institute (K.H.W., A.L., I.S.C., J.A.T., J.R.L.), Boston, Massachusetts, USA; Brigham and Women's Hospital (K.H.W., V.L., A.L., I.S.C., A.J.R, J.R.L.), Boston, Massachusetts, USA; Spaulding Rehabilitation Hospital for Continuing Care (K.H.W., A.D.), Cambridge, Massachusetts, USA; Harvard Medical School (K.H.W., A.L., E.B.R., I.S.C., N.N.U., A.J.R., J.A.T., J.R.L.), Boston, Massachusetts, USA.
Clinicians generally support palliative care for patients with chronic critical illness (CCI). They believe these services should be available and trust palliative care specialists to manage CCI patients.
Area of Science:
- Critical Care Medicine
- Palliative Care
- Health Services Research
Background:
- Chronic critical illness (CCI) survivors face worse outcomes than metastatic lung cancer patients.
- Palliative care access is limited in long-term acute care hospitals, despite its routine use in cancer centers.
- Clinician attitudes towards palliative care in CCI are not well understood.
Purpose of the Study:
- To assess clinician attitudes regarding palliative care for patients with chronic critical illness.
- To identify potential barriers or facilitators to palliative care integration in CCI.
Main Methods:
- Cross-sectional survey of clinicians in two ventilator-weaning units.
- Data collection via free-text associations and Likert scale agreement with palliative care statements.
- Analysis using inductive content analysis, descriptive statistics, and Fisher's exact tests.
Main Results:
- High clinician participation (78.5%) across 11 professions.
- Clinicians associated palliative care with comfort and support.
- Over 95% of clinicians agreed on the need for palliative care services for CCI and trusted palliative care specialists.
Conclusions:
- Clinicians are receptive to palliative care involvement in chronic critical illness.
- Opportunities exist to integrate palliative care expertise into long-term acute care settings for CCI patients.
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