TY - JOUR
T1 - Interpersonal Conflict between Clinicians in the Delivery of Palliative and End-of-Life Care for Critically Ill Patients
T2 - A Secondary Qualitative Analysis
AU - Tong, Wendy
AU - Murali, Komal P.
AU - Fonseca, Laura D.
AU - Blinderman, Craig D.
AU - Shelton, Rachel C.
AU - Hua, May
N1 - Funding Information:
This work was supported by the American Federation for Aging Research, the National Institute on Aging, and the National Institute of Nursing Research. The funding sources were not involved in the design and conduct of the study, interpretation of data, preparation of the article, or in the decision to submit the article for publication.
Funding Information:
M.H. is supported by a Paul B. Beeson Career Development Award K08AG051184 from the National Institute on Aging and the American Federation for Aging Research. K.P.M. is supported by the Comparative and Cost-Effectiveness Research Training for Nurse Scientists (CER2; T32NR014205). There are no additional conflicts of interest to report.
Publisher Copyright:
© Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: Conflict between clinicians is prevalent within intensive care units (ICUs) and may hinder optimal delivery of care. However, little is known about the sources of interpersonal conflict and how it manifests within the context of palliative and end-of-life care delivery in ICUs. Objective: To characterize interpersonal conflict in the delivery of palliative care within ICUs. Design: Secondary thematic analysis using a deductive-inductive approach. We analyzed existing qualitative data that conducted semistructured interviews to examine factors associated with variable adoption of specialty palliative care in ICUs. Settings/Subjects: In the parent study, 36 participants were recruited from two urban academic medical centers in the United States, including ICU attendings (n = 17), ICU nurses (n = 11), ICU social workers (n = 1), and palliative care providers (n = 7). Measurements: Coders applied an existing framework of interpersonal conflict to guide initial coding and analysis, combined with a flexible inductive approach allowing new codes to emerge. Results: We characterized three properties of interpersonal conflict: disagreement, interference, and negative emotion. In the context of delivering palliative and end-of-life care for critically ill patients, "disagreement"centered around whether patients were appropriate for palliative care, which care plans should be prioritized, and how care should be delivered. "Interference"involved preventing palliative care consultation or goals-of-care discussions and hindering patient care. "Negative emotion"included occurrences of silencing or scolding, rudeness, anger, regret, ethical conflict, and grief. Conclusions: Our findings provide an in-depth understanding of interpersonal conflict within palliative and end-of-life care for critically ill patients. Further study is needed to understand how to prevent and resolve such conflicts.
AB - Background: Conflict between clinicians is prevalent within intensive care units (ICUs) and may hinder optimal delivery of care. However, little is known about the sources of interpersonal conflict and how it manifests within the context of palliative and end-of-life care delivery in ICUs. Objective: To characterize interpersonal conflict in the delivery of palliative care within ICUs. Design: Secondary thematic analysis using a deductive-inductive approach. We analyzed existing qualitative data that conducted semistructured interviews to examine factors associated with variable adoption of specialty palliative care in ICUs. Settings/Subjects: In the parent study, 36 participants were recruited from two urban academic medical centers in the United States, including ICU attendings (n = 17), ICU nurses (n = 11), ICU social workers (n = 1), and palliative care providers (n = 7). Measurements: Coders applied an existing framework of interpersonal conflict to guide initial coding and analysis, combined with a flexible inductive approach allowing new codes to emerge. Results: We characterized three properties of interpersonal conflict: disagreement, interference, and negative emotion. In the context of delivering palliative and end-of-life care for critically ill patients, "disagreement"centered around whether patients were appropriate for palliative care, which care plans should be prioritized, and how care should be delivered. "Interference"involved preventing palliative care consultation or goals-of-care discussions and hindering patient care. "Negative emotion"included occurrences of silencing or scolding, rudeness, anger, regret, ethical conflict, and grief. Conclusions: Our findings provide an in-depth understanding of interpersonal conflict within palliative and end-of-life care for critically ill patients. Further study is needed to understand how to prevent and resolve such conflicts.
KW - conflict
KW - critical illness
KW - intensive care units
KW - palliative care
KW - psychological
KW - referral and consultation
UR - http://www.scopus.com/inward/record.url?scp=85139571659&partnerID=8YFLogxK
U2 - 10.1089/jpm.2021.0631
DO - 10.1089/jpm.2021.0631
M3 - Article
C2 - 35363575
AN - SCOPUS:85139571659
SN - 1096-6218
VL - 25
SP - 1501
EP - 1509
JO - Journal of Palliative Medicine
JF - Journal of Palliative Medicine
IS - 10
ER -