Integrating palliative care and ICU
14th June 2022
A recent article in Intensive Care Medicine has highlighted the need to develop a consensus and disseminate skills and training in order to provide high quality care in intensive care units (ICUs).
From the inception of the intensive care unit (ICU), end-of-life care has always been delivered in this setting due to the high severity of illness of the patients. But over time there has been an important distinction drawn between the primary palliative care that is provided by any clinician caring for a patient with life-threatening illness and the specialty palliative care provided by those with specialty training in palliative care.
Approaches have evolved including: primary palliative care provided by ICU; palliative care provided by specialist palliative care teams; and a mixed approach combining both aspects.
Successful use of the mixed model depends on successful interprofessional collaboration between the ICU and palliative care teams when supporting individual patients and their families. There is some evidence that incorporating palliative care specialists to run one or two family meetings without full integration with the ICU team provides no benefit and may even result in increased post-traumatic stress for family members. Triggers for palliative care consultation often focus on risk of mortality but this may not correlate with unmet palliative care needs.
The best approach for how patients’ and families’ palliative care needs are met and how primary and specialty palliative care are integrated will vary from ICU to ICU, but the functions of providing high-quality palliative care to critically ill patients and their families are universal.
The authors make 3 recommendations:
ICU clinicians, including physicians, nurses, and others, need training and experience in primary palliative care skills relevant in the ICU. Such skills include symptom assessment and management, parallel planning for diverse outcomes, communication with and support for critically ill patients and their families, and shared decision-making with patients and families that is inclusive of the interprofessional team. It is important to implement efficient and effective ways to identify those patients and family members who would benefit most from specialty palliative care.
Curtis, J.R., Higginson, I.J. & White, D.B. Integrating palliative care into the ICU: a lasting and developing legacy. Intensive Care Med (2022). https://doi.org/10.1007/s00134-022-06729-7