Knowledge and Awareness of End-of-life Care among Doctors Working in Intensive Care Units at a Tertiary Care Center: A Questionnaire-based Study
Kritika Agrawal, Sushma Bhatnagar
Awareness, Critical care unit, Doctors, End-of-life care, Intensivist, Knowledge, Palliative care
Citation Information :
Agrawal K, Bhatnagar S. Knowledge and Awareness of End-of-life Care among Doctors Working in Intensive Care Units at a Tertiary Care Center: A Questionnaire-based Study. Indian J Crit Care Med 2019; 23 (12):568-573.
Introduction: End-of-life care (EOLC) is an increasingly important concern in the management of terminally ill patients. Effective EOLC depends significantly on the physicians working in the critical care units. Thus, adequate knowledge of critical care professionals regarding EOLC is important. We conducted this study to evaluate the awareness and knowledge of doctors working in critical care units toward EOLC.
Materials and methods: Doctors working in critical care units were invited to fill paper-based questionnaire. The validated questionnaire was constructed based on the existing literature on EOLC and expert opinion. The questionnaire comprised four sections: demographic details, experience with EOLC situations, general awareness of EOLC, and specific awareness of EOLC in clinical practice. The collected data were analyzed by descriptive analysis.
Results: Most respondents had not counseled more than five families regarding EOLC over 1 month. Majority of the respondents (81.7%) had heard of EOLC; the major source of information being their work in the concerned specialty. Only 29.2% of the respondents applied EOLC principles in their clinical practice. Main barriers were lack of information and training. Only 20.3% of the respondents were aware of Indian guidelines about EOLC. Majority of the respondents disagree regarding the usage of critical care units and resuscitation of terminally ill patients and were in favor of home care. One-third respondents felt uncomfortable in discussing EOLC issues with the families. Half of the respondents felt that they were only somewhat competent in managing EOLC issues. Most respondents opined that training and education in medical curriculum for terminally ill patients are lacking and were in strong favor of inclusion of specific training for the same.
Conclusion: The EOLC needs to be an integral part of critical care management and teaching curriculum. An integral referral system may also be an option for various advance disease patients getting treatment from critical care specialists for EOLC decision.
Macaden SC, Salins N, Muckaden M, Kulkarni P, Joad A, Nirabhawane V, et al. End of life care policy for the dying: consensus position statement of Indian Association of Palliative Care. Indian J Palliat Care 2014;20(3):171–181. DOI: 10.4103/0973-1075.138384.
Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the critical care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008;36(3):953–963. DOI: 10.1097/CCM.0B013E3181659096.
Papadimos TJ, Maldonado Y, Tripathi RS, Kothari DS, Rosenberg AL. An overview of end-of-life issues in the critical care unit. Int J Crit Illn Inj Sci 2011;1(2):138–146. DOI: 10.4103/2229-5151.84801.
Prendergast TJ, Luce JM. Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med 1997;155(1):15–20. DOI: 10.1164/ajrccm.155.1.9001282.
Sullivan A, Lakoma M, Block S. The status of medical education in end-of-life care. J Gen Intern Med 2003;18(9):685–695. DOI: 10.1046/j.1525-1497.2003.21215.x.
Sprung CL, Cohen SL, Sjokvist P, Lippert A, Phelan D. End-of-life practices in European intensive care units: the Ethicus Study. JAMA 2003;290(6):790–797. DOI: 10.1001/jama.290.6.790.
Carlet J, Thijs LG, Antonelli M, Cassell J, Cox P, Hill N, et al. Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med 2004;30(5):770–784. DOI: 10.1007/s00134-004-2241-5.
Mani R, Amin P, Chawla R, Divatia J, Kapadia F, Khilnani P, et al. Guidelines for end-of-life and palliative care in Indian critical care units’ ISCCM consensus Ethical Position Statement. Indian J Crit Care Med 2012;16(3):166–181. DOI: 10.4103/0972-5229.102112.
Myatra S, Salins N, Iyer S, Macaden S, Divatia J, Muckaden M, et al. End-of-life care policy: an integrated care plan for the dying. Indian J Crit Care Med 2014;18(9):615–635. DOI: 10.4103/0972-5229.140155.
Sadhu S, Salins NS, Kamath A. Palliative care awareness among Indian undergraduate health care students: a needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education. Indian J Palliat Care 2010;16(3):154–159. DOI: 10.4103/0973-1075.73645.
Sharma H, Jagdish V, Anusha P, Bharti S. End-of-life care: Indian perspective. Indian J Psychiatry 2013;55(Suppl 2):S293–S298. DOI: 10.4103/0019-5545.105554.
Chen E, McCann JJ, Lateef OB. Attitudes toward and experiences in end-of-life care education in the critical care unit: a survey of resident physicians. Am J Hosp Palliat Med 2015;32(7):738–744. DOI: 10.1177/1049909114539038.
Mohamed ZU, Muhammed F, Singh C, Sudhakar A. Experiences in end-of-life care in the critical care unit: a survey of resident physicians. Indian J Crit Care Med 2016;20(8):459–464. DOI: 10.4103/0972-5229.188196.
Tripathy S, Routray PK, Mishra JC. Intensive care nurses’ attitude on palliative and end of life care. Indian J Crit Care Med 2017;21(10): 655–659. DOI: 10.4103/ijccm.IJCCM_240_16.
Vejlgaard T, Addington-Hall JM. Attitudes of Danish doctors and nurses to palliative and terminal care. Palliat Med 2005;19(2):119–127. DOI: 10.1191/0269216305pm988oa.
Kassa H, Murugan R, Zewdu F, Hailu M, Woldeyohannes D. Assessment of knowledge, attitude and practice and associated factors towards palliative care among nurses working in selected hospitals, Addis Ababa, Ethiopia. BMC Palliat Care 2014;13(1):6. DOI: 10.1186/1472-684X-13-6.