Palliative Care: Attitudes and Practices of Trauma Care Providers

Abstract

Background: Palliative care focuses on improving quality of life for patients and their families by providing relief from the stress, pain, and other symptoms of a serious disease or injury. Trauma care has a heavy focus on improving resuscitation efforts, which has left little room in the literature for studies on utilization of palliative care in this population. Objective: The purpose of this DNP project was to better understand the use of palliative care for trauma patients at a Level 1 trauma center in southern Arizona to inform a future quality improvement (QI) project. Project Design: A survey was completed to determine 1) how palliative care is utilized for trauma patients at this institution; 2) what barriers exist for the use of palliative care in this population; 3) what is the culture of the trauma team regarding palliative care; and 4) whether there are differences in palliative care use between physicians and advanced practice providers (APPs) on the trauma service. Participants and Setting: Eleven trauma APPs and attending physicians at a Level 1 trauma center in southern Arizona. Measurements: APPs and physicians were surveyed using a survey tool created by the author to answer the project questions. This survey assessed barriers to the use of palliative care, situations and patient characteristics prompting palliative consults, previous education in palliative care, comfort with difficult topics and symptoms, and suggestions for improving palliative care use at this facility. Results: As a team, there was agreement between APPs and attending physicians that lack of timely availability of palliative care staff was a barrier to initiating consults, in addition resistance from families regarding palliative care. Both groups were also likely to consult palliative care for assistance with transitions of care and when there is family conflict in decision making. Both groups felt that increased availability of palliative staff to cover nights and weekends, as well as provider education on palliative concepts would improve utilization of palliative care. Conclusion: Future QI projects should focus on provider-identified interventions to improve palliative care use, such as continuing education on palliative care and increased availability of palliative care staff.