palliative care; critical care; terminal conditions; end of life; barriers; intensive care unit


Palliative care is of value to the quality of life in people with terminal conditions when initiated early. The purpose of this literature review was to identify barriers to early initiation of palliative care consultation. The secondary purpose was to examine characteristics that prompt palliative care consultation. The TLC model of palliative care was used to explore palliative care in the critical care setting in people with terminal conditions. The concepts of the model support optimal palliative care as collaborative and comprehensive, with shared decisions made by the patient, practitioners, and loved ones. A literature review was conducted to identify common barriers to early initiation of palliative care consults in the critical care setting for people with terminal conditions. Peer-reviewed articles were retrieved from the EBSCOhost, Medical Literature On-Line (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Elsevier databases to evaluate their relevance to palliative care in the critical care setting. Twelve preliminary studies were selected for review per the inclusion criteria. Eleven studies identified education and legal factors as barriers. Six studies identified patient and family perceptions as barriers. Five studies identified practitioner-related bias as a significant barrier to consultation. Of the twelve articles reviewed, ten articles referred to palliative care in the adult ICU setting. Two articles included in the review examined barriers to palliative care in the neonatal and pediatric settings. The analysis of the data identified three categories as barriers to initiation of end-of-life care: practitioner-related bias, patient and family perceptions, and education and legal factors after a synthesis of the relevant literature was performed. Analysis of the articles suggests early identification of potential diagnoses for palliative consultation beginning in the intensive care unit (ICU) can improve symptom management, support, patient- centered care, and quality of life for people with terminal conditions. Barriers related to all three categories dominated the literature, with the most prominent being barriers related to education and legal factors. Results indicate that development and implementation of a palliative care referral tool can increase consultation for patients in the critical care setting with terminal conditions. Further education on the topic can increase understanding of palliative care services and improve provision of palliative care through early referrals and consultation.

Thesis Completion Year


Thesis Completion Semester


Thesis Chair

D'Amato-Kubiet, Leslee


College of Nursing

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Access Status

Open Access

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Campus Location

UCF Daytona Beach



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In Copyright