ASSESSING PALLIATIVE CARE DELIVERY IN A NEURO ICU: PREDICTING END-OF-LIFE EXPERTISE

摘要

This study assesses palliative care implementation in the Neuro ICU of a large medical center. The expectation of death at admission is high, making comprehensive palliative care vital. The aim was to examine how providers’ views of palliative care are related to their end-of-life (EOL) expertise. Forty-one providers responded to 25 questions (Likert-type scales) concerning their views of palliative care delivery. EOL expertise (e.g., ethical issues, clear definition of palliative care, avoiding futile care) was also assessed. Exploratory factor analysis of views of care delivery (Varimax rotation, 44.26% variance explained) resulted in three factors reflective of increasing levels of palliative care provision: initiating the process, providing basic comfort-care, and delivering holistic care. Linear regression analyses used these three factors to predict EOL expertise. Endorsing Delivery of Holistic Care predicts the use of ethics consults to aid complex care decisions (B = .96, p = .001) and avoidance of administering futile care (B = .68, p = .05). Endorsing Provision of Basic Comfort Care predicts greater previous palliative care involvement (B = 1.23, p = .008). Endorsing Initiation of the Process predicts having a more comprehensive definition of palliative care (B = 2.34, p = .005) and of Advance Directives (B = 1.23, p = .013). Results suggest that different ways of viewing palliative care exist even within a single unit and that these views are related to providers’ expertise in dealing with ethical issues, end of life planning, and delivery of care.