Intensivists' Perspectives and Practices on Palliative Care in the ICU: A Nationwide Survey in Korea.

Abstract

Background: While many countries have made progress in integrating palliative care into intensive care units (ICUs), implementation remains highly context-dependent. In Korea, palliative care integration within ICUs remains limited, and intensivists' perspectives on its role and applicability have not been well studied.

Methods: We conducted a nationwide, cross-sectional online survey of certified intensivists and fellows registered with the Korean Society of Critical Care Medicine between April and May 2024. The questionnaire explored knowledge and confidence in palliative care, current ICU practices, referral patterns, perceived barriers, and preferred strategies for integration.

Results: A total of 241 intensivists responded (response rate, 23.9%). Most agreed that palliative care should be incorporated into ICU care (97.1%) and were willing to make referrals (98.3%). Advance care planning, symptom management, and family decision-making were the most expected domains of support. However, fewer reported involvement in psychological support, end-of-life care, or bereavement services. Referral practices were more frequent in institutions with palliative care teams, while lack of resources, unsupportive institutional culture, and unclear processes were commonly cited barriers. Clinical guidelines, professional education, and reimbursement reform were identified as priority strategies for integration.

Conclusion: Korean intensivists widely recognize the need for palliative care in the ICU but apply it within a limited scope. To strengthen integration, consensus on definitions, clear referral criteria, and supportive institutional and policy frameworks are required.