Screening and Management of Suffering Symptoms,Needs,and Specialized Palliative Care Utilization in Critical Care: Barriers and Perspectives From a Nationwide Survey of Japanese Critical Care Specialist Nurses

Abstract

Aims

Patients in critical care settings often experience significant suffering, and managing their symptoms can be challenging. This study aimed to clarify the status of routine symptom screening by critical care specialist nurses, the challenges in symptom management, the recognition of the need for specialized palliative care, the rates of consultations with palliative care teams, and perceived barriers to using these teams.

Methods

A nationwide cross-sectional survey was conducted among 740 specialist nurses, including certified emergency nurses, certified intensive care nurses, and critical care nursing specialists, working in critical care settings across Japan.

Results

Of the 740 questionnaires distributed, 384 (51.9%) were analyzed. Over 90% of specialist nurses reported routinely screening for pain (93.5%). They identified significant challenges in managing symptoms such as fatigue (80.5%), anxiety and depression (80.2%), insomnia (72.9%), and delirium (71.4%). While there was strong recognition of the need for specialized palliative care, particularly for intractable pain (87.5%), actual rates of utilization remained low (26.6%). Similarly, although 75.3% recognized the need for palliative care teams for patients with serious illness at the end of life, only 20.8% consulted. For patients staying in the intensive care unit for over 7 days, 11.7% recognized the need for referral to a palliative care team, with only 2.3% actually consulting one. The primary barrier identified was difficulty in making timely referrals (64.3%).

Conclusions

Improving symptom screening and consultations with palliative care teams in critical care settings in Japan, along with developing targeted palliative care education and consultation systems, is essential.