Opportunities for Palliative Care in Long-Term Acute Care: A Concurrent Mixed-Methods Study.

Abstract

Chronic critical illness (CCI)-surviving acute critical illness but requiring prolonged mechanical ventilation-predicts worse one-year outcomes than metastatic non-small cell lung cancer. Although palliative care is routinely integrated into cancer centers, long-term acute care hospitals-to which most patients with CCI are discharged after their acute critical illness-report limited palliative care access. Whether clinician attitudes discourage palliative care involvement in CCI care is unknown. To evaluate clinician attitudes towards palliative care for patients with CCI. We recruited clinicians from two ventilator-weaning units as part of a larger cross-sectional study. Survey responses included free-text associations with the term "palliative care" and 4-point Likert scales of agreement with statements about palliative care. We used inductive content analysis, descriptive statistics, and Fisher's exact tests in sensitivity analyses. Two hundred seventy-four of 349 eligible clinicians participated in the survey (response rate 78.5%), representing 11 professions, with similar response rates across sites and professions. Clinicians most often associated "palliative care" with comfort and support but perceived patients as associating "palliative care" with death and less treatment. Nearly all clinicians agreed that centers caring for CCI should have palliative care services (N = 261, 97.4%) and they could trust a palliative care clinician to care for their patients with CCI (N = 257, 95.9%). Clinicians encourage palliative care involvement for CCI. These results emphasize opportunities to integrate palliative care expertise into long-term acute care.