Utilization and determinants of palliative care in the trauma intensive care unit: Results of a national survey. (September 2014) - Karlekar, Mohana
Background: There is a paucity of data evaluating utilization of palliative care in trauma intensive care units. Aim: We sought to determine current indications and determinants of palliative care consultation in the trauma intensive care units. Design: Using a cross-sectional assessment, we surveyed trauma surgeons to understand indications, benefits, and barriers trauma surgeons perceive when consulting palliative care. Setting/participants: A total of 1232 surveys were emailed to all members of the Eastern Association for the Surgery of Trauma. Results: A total of 362 providers responded (29% response rate). Majority of respondents were male ( n = 287, 80.2%) and practiced in Level 1 ( n = 278, 77.7%) trauma centers. Most common indicators for referral to palliative care were expected survival 1 week to 1 month, multisystem organ dysfunction >3 weeks, minimal neurologic responsiveness >1 week, and referral to hospice. In post hoc analysis, there was a significant difference in frequency of utilization of palliative care when respondents had access to board-certified palliative care physicians ( χ 2 = 56.4, p < 0.001). Although half of the respondents ( n = 199, 55.6%) reported palliative care consults beneficial all or most of the time, nearly still half ( n = 174, 48.6%) felt palliative care was underutilized. Most frequent barriers to consultation included resistance from families ( n = 144, 40.2%), concerns that physicians were "giving up" ( n = 109, 30.4%), and miscommunication of prognosis ( n = 98, 27.4%) or diagnosis ( n = 58, 16.2%) by the palliative care physician. Conclusion: Although a plurality of trauma surgeons reported palliative care beneficial, those surveyed indicate that palliative care is underutilized. Barriers identified provide important opportunities to further appropriate utilization of palliative care services.