Understanding the Intricacies of Delivering Compassionate Care in the Intensive Care Unit and What Hinders It: A Qualitative Study of Members of 2 Critical Care Societies

Abstract

BACKGROUND: Patient-centered care is increasing in importance especially in the post-coronavirus disease 2019 (COVID-19) pandemic era. We sought to understand factors affecting compassionate care faced by intensivists in the intensive care unit (ICU). METHODS: Using survey methodology incorporating 3 real-life case vignettes, responses were elicited to difficult ethical and moral dilemmas in the ICU setting. Members of 2 critical care societies in the United States and Europe were included in the survey. RESULTS: Responses from 323 intensivists (32% out of 1000 members who opened the initial email invitation) around the world were analyzed thematically. Conflicts between patient choices and suggested medical care, institutional/work constraints restricting compassionate care and leading to burnout, and personal variables influencing compassionate care were the themes that emerged from our investigation. The results demonstrate that intensivists have compassion for their patients and want to provide patient-centered care, but also experience stress due to their limited ability to improve their patients' conditions. CONCLUSIONS: Compassionate attitudes can be hindered by an underlying worry about the decision made by the patient and their family, a lack of confidence in making hard moral decisions, and the burdens of burnout. (Anesth Analg 2023;137:162-8) KEY POINTS• Question: How is compassionate care by intensivists affected in the intensive care unit (ICU)? • Findings: Compassionate care is impacted by (1) the marked unease felt by participants toward the decision-making of patients and their families, which is frequently underpinned by a lack of confidence in their own judgments regarding value-laden decisions, and (2) burnout and a lack of sufficient time, both of which result in a lack of compassionate behavior. • Meaning: This study suggests that intensivists felt compassion but at times could not act compassionately and, therefore, felt stress or burnout.