Nationwide Survey of Physician’s Attitudes Toward Palliative Care for Patients in the ICU in Japan

Background Patients in intensive care units (ICU) frequently face severe distress and complex ethical dilemmas, underscoring the critical role of palliative care. Despite growing international attention on ICU-based palliative care, the attitude of palliative care specialists remains unclear. In Japan, although ICU physicians express willingness to collaborate, actual engagement with palliative care teams is limited. To support palliative care integration in the ICU, understanding specialists’ perspectives on its provision to ICU patients is critical. Objectives We examined the attitudes, confidence, motivation, and perceived barriers among Japanese palliative care specialists regarding their provision of care in the ICU. Design We conducted a nationwide cross-sectional survey. Setting/Subjects Conducted in Japan in June 2023, targeting 335 board-certified palliative care physicians. Measurements Attitudes, confidence, motivation, and perceived barriers were assessed using a self-administered questionnaire with five-point Likert scales. Descriptive statistics with 95% confidence intervals were generated. Results Responses from 218 physicians were received (65.0% valid response rate). Among these, although 65.5% agreed that palliative care is important even when curative goals are present, <30% reported confidence in prognostication, symptom management, or understanding ICU culture. Motivation to engage in ICU care was also limited. Primary barriers identified were lack of reimbursement (77.2%) and insufficient ICU-specific education (72.5%). Conclusion Despite acknowledging its importance, Japanese palliative care specialists demonstrate limited preparedness for ICU-based palliative care. Our findings highlight an urgent need for specialized education, improved interdisciplinary collaboration, and removal of financial disincentives, including the absence of reimbursement for ICU palliative care consultations under Japan’s health insurance system.