Barriers to quality end-of-life care in West Virginia ICU units: physicians' and nurses' prospectives.

Most deaths in West Virginia occur in hospitals and a high proportion take place in intensive care units (ICU). This study was undertaken to determine what West Virginia physicians and nurses treating patients in ICUs perceive to be the barriers to quality end-of-life care. A total of 626 physicians and nurses practicing in 28 hospitals completed surveys and the results showed that physicians and nurses agree the top three barriers are patient/family demands for all possible treatment; inadequate insurance coverage; and lack of health care professional education. The study indicated that the majority of physicians were satisfied with their end-of-life care skills. In addition, it showed that physicians referred an average of 10 patients to hospice in the preceding year and that they did not refer more patients because the patient or family did not accept that the patient was dying. Futher education of physicians, nurses and especially the public is needed to improve end-of-life care in West Virginia.