Perspectives of physicians and nurses on palliative and end-of-life care practices in ICU beyond the COVID-19 era: An European survey study

Background: The practice of end-of-life (EOL) and palliative care was modified during the coronavirus disease 2019 (COVID-19) pandemic due to several factors, often related to isolation and infection prevention measures. This study aims to explore the current state of EOL and palliative care after the COVID-19 pandemic in European Intensive Care Units (ICUs). Methods: The online cross-sectional survey study was endorsed by the European Society of Intensive Care Medicine (ESICM). Data collection was carried out in ten months (May 2023 to February 2024). Healthcare professionals (HCPs) working in European ICUs were eligible to participate. Univariate and multivariate logistic regression model was used for statistical analysis. Results: Totally, 215 HCPs completed the survey. Patients’ dying without dignity was perceived by 17 (9%) HCPs. The statistically significant factor contributing to perception of dying without dignity was unclear goals of treatment in EOL. Inappropriate care after the COVID-19 pandemic was perceived by 38 nurses (78%) and 127 physicians (91%). Organ support was reported as too long by 109 physicians (72%) and 32 nurses (50%), while 88 physicians (58%) and 16 nurses (25%) perceived organ support as too extensive. When organ support was perceived as inappropriate, 27 nurses (75%) and 113 physicians (90%) actively expressed their concerns. However, these expressed opinions were not respected in 40 physicians (35%) and 14 nurses (52%). Moral distress was perceived as an issue even after the COVID-19 pandemic among 129 (72%) respondents. HCPs whose EOL practices changed during the COVID-19 pandemic had nearly 8 times higher odds (OR (95% CI) 7.969 (2.890–21.975)) of experiencing moral distress post-pandemic (p < 0.0001). Among the HCPs who acknowledged the presence of moral distress after the pandemic, 65 (50%) felt that the level of distress was comparable to pre-pandemic levels. Conclusions: Palliative care at ICU after the COVID-19 pandemic has the potential for improvement in dignified dying and appropriate care. The major factor connecting the moral distress of HCPs and improvement in palliative care quality seems to be communication. Further research and interventions to improve communication among the HCPs and between HCP and family might benefit patients and also HCPs. Trial registration ClinicalTrials.gov (NCT05089032)