Barriers to Palliative Care in Critical Care Settings within the United States

Annually, over five million patients are admitted to intensive-care units in the United States. There, patients receive an increased level of care and close monitoring which prioritizes their physical wellbeing over their personal needs. Palliative care seeks to help anticipate, alleviate, and prevent suffering while curative therapies are pursued. Currently, palliative care is underutilized in critical care settings leading to increased healthcare costs and perpetuates distressing healthcare experiences. This review sought to examine existing literature regarding barriers to the implementation of palliative care in critical care settings. An integrative review was performed, evaluating literature available in two prominent databases. Following the systemic screening process, four articles were included for data extraction, appraisal, and synthesis. The articles revealed four overarching themes of time constraints, lack of education/understanding from staff and patients/families, difficulties coordinating care, and patient/provider attitudes and interactions. Time constraints was referenced in two of four articles, lack of education/understanding was referenced in three of four articles, difficulties coordinating care was referenced in two of four articles, and patient/provider attitudes and interactions was referenced in three of four articles. Further research should be conducted to examine barriers to the implementation of palliative care in critical care settings given the limited amount of existing research.