TABLE 2.

Barriers to Better Integration of Palliative Care and Critical Care (56–58)

Unrealistic expectations for intensive care therapies on the  part of patients, families, and clinicians

Misperception of palliative care and critical care as mutually  exclusive or sequential rather than complementary and  concurrent approaches

Conflation of palliative care with end-of-life or hospice care

Concern that incorporation of palliative care will hasten death

Insufficent training of clinicians in communication and other  necessary skills to provide high-quality palliative care

Competing demands on ICU clinician effort, without adequate  reward for palliative care excellence

Failure to apply effective approaches for system or culture  change to improve palliative care