Attitudes and Dilemmas in Initiating Rehabilitation During Palliative Care: A Qualitative Study of Nurses and Physicians in Chinese Respiratory Intensive Care Units

BACKGROUND: Recent policy recommendations have advocated for integrating rehabilitation into palliative care. However, multiple barriers exist in clinical practice. Specifically, there is a lack of research on the attitudes and dilemmas of nurses and physicians in Chinese Respiratory Intensive Care Units (RICUs) toward initiating rehabilitation for patients receiving palliative care. AIM: To explore attitudes and dilemmas among Chinese RICU nurses and physicians regarding rehabilitation initiation in palliative care. STUDY DESIGN: A descriptive qualitative study was conducted. Semi-structured interviews were carried out with 12 nurses and 5 physicians from two RICUs. The interview data were analysed using thematic analysis. The study followed the Consolidated Criteria for Reporting Qualitative Research. FINDINGS: Three main themes emerged: (main theme 1) Attitudes toward palliative rehabilitation (subtheme 1: transformation of rehabilitation goals, subtheme 2: ambiguous link between palliative care and rehabilitation); (main theme 2) Dilemmas in initiating palliative rehabilitation (subtheme 1: passive decision-making regarding intervention timing, subtheme 2: family-driven divergence in needs, subtheme 3: challenges in collaborative communication, subtheme 4: constraints in rehabilitation resources); (main theme 3) Adaptive strategies (subtheme 1: establishing partnership and making goals tangible, subtheme 2: pre-rehearsal and progressive disclosure). CONCLUSIONS: Although nurses and physicians share consistent palliative rehabilitation goals, the integration of RICU-based rehabilitation into palliative care is constrained by systemic resource limitations, patient and family preferences, ambiguous interdisciplinary roles and a prevailing informal rehabilitation culture. Addressing these constraints may facilitate the advancement of palliative rehabilitation. RELEVANCE TO CLINICAL PRACTICE: Establishing standardized palliative rehabilitation protocols, clarifying multidisciplinary roles, particularly in defining nurses' scope of communication, providing communication training focused on managing family needs and expectations and fostering an appropriate rehabilitation culture to alleviate nurses' emotional distress may help resolve the challenges of initiating palliative rehabilitation.