Table 3.

Barriers to Optimal End-of-Life Care in the SICU

Logistics
Often only a small window when can offer end-of-life care
Prognosis is often uncertain
Patient often cannot be involved in discussions
Lack of palliative care service for surgical patients
Unclear patient advance directives
Unclear surrogate decision maker for patient
Few other care resources beyond an ICU for patients on advanced life support

Inability to acknowledge an end-of-life situation
Families are often given “false hope”
Care providers often have “false hope”
Differences in opinions amongst care providers regarding prognosis

Education
Poor communication between care providers
Care providers uncomfortable discussing end-of-life care
Poor knowledge concerning available resources (chaplaincy, palliative care, hospice)
Not all care options are understood and/or presented
Poor care provider training in providing end-of-life care
Families do not understand the technologies used in ICU to keep patient “alive”

Cultural barriers
Care providers and families uncomfortable discussing end-of-life care
Prognosis is often uncertain–patient death is seen as a defeat by care providers and/or families
Hospice is rarely discussed as a care option
End-of-life situations are particularly difficult when the patient is younger
Disagreements about whether the patient should be involved in the discussion
Patient cultural beliefs that contrast with those of the care providers
Unclear as to what is a “natural death” or what are “extreme measures” or “futile
Measures,” particularly when a patient is already on life support in an ICU