Stephanie Meddick-Dyson is an Academic Clinical Fellow in Palliative Medicine working in Yorkshire. She trained in acute medicine with intensive care and emergency care experience, developing her clinical and research interest in acute palliative care. Her research, based at the Wolfson Palliative Care Research Centre, focuses on optimising palliative and end-of-life care services in the intensive care unit. Stephanie is co-chair of the End-of-life and Palliative Care in the ICU Research Network (EPCIN), a network she developed to share knowledge and encourage collaboration in the field. Holding high regard for the translation of evidence to practice, Stephanie’s work is underpinned by implementation science. She is working towards helping ICUs successfully implement their complex interventions to provide palliative care, by understanding the implementation factors, and processes involved.
If successfully implemented, palliative care interventions within Intensive Care Units (ICU) support patients and relatives in times of uncertainty and distress. This study aims to understand professional perspectives about providing palliative care within Intensive Care Units in the UK.
UK healthcare professionals with experience of providing or organising palliative care in the ICU were asked to complete the validated 23-item Normalisation MeAsure Development survey with 20 core items organised by Normalisation Process Theory constructs. Free text comments were thematically synthesised for further insight into how professionals work to provide palliative care in their ICU.
153 completed surveys; 69% of respondents were ICU professionals, 31% were palliative care professionals. Respondents reported being familiar with palliative care in the ICU and that it was part of their normal work. Respondents had positive perspectives about implementation of palliative care in the ICU, reporting positively about coherence (sense-making work), cognitive participation (relational work) and reflexive monitoring (appraisal work). Rating of collective action (operational work) were more negatively perceived. Free-text responses revealed themes reflecting (i) professional roles within the ICU, including the significant interplay between ICU doctors and nurses, the benefits, and difficulties of specialist palliative care involvement, and the nuances of ICU care that require specialist knowledge. (ii) Timing of provision, comprising mixed perceptions of the ability to recognise the need for palliative care and how it is a routine part of ICU care. (iii) Challenges to providing palliative care in the ICU including conflicts, pressures, lack of training, and the need to avoid medicalisation of death.
The understanding and value of, and motivation for, providing palliative care in the ICU is promising. Important implementation gaps may lie within operational work. Future work is needed around resources and training to support palliative care provision and navigating the complex, but vital, interplay between multidisciplinary teams.