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Palliative Care in the ICU

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Evidence-Based Critical Care

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Abstract

Intensive care medicine has previously focused on the treatment of acute illness, but as clinicians become more skilled at treating chronic disease, many patients are left in a state of chronic critical illness. Nearly 20% of all Medicare beneficiaries will see the ICU in the last month of life. Therefore, it has been increasingly important for ICU clinicians to address palliative care in the ICU. Areas of research have included communication interventions, proactive palliative care involvement, palliative care triggers, and spiritual support. While no definitive strategies exist for palliative care involvement in the ICU, improving communication skills of clinicians is a vital part of delivering patient centered palliative care in the intensive care unit.

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References

  1. Teno JM, Gozalo P, Trivedi AN, Bunker J, Lima J, Ogarek J, et al. Site of death, place of care, and health care transitions among US Medicare beneficiaries, 2000–2015. JAMA. 2018;320(3):264–71.

    Article  Google Scholar 

  2. Teno JM, Gozalo PL, Bynum JP, Leland NE, Miller SC, Morden NE, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470–7.

    Article  CAS  Google Scholar 

  3. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182(4):446–54.

    Article  Google Scholar 

  4. Viglianti EM, Kramer R, Admon AJ, Sjoding MW, Hodgson CL, Bellomo R, et al. Late organ failures in patients with prolonged intensive care unit stays. J Crit Care. 2018;46:55–7.

    Article  Google Scholar 

  5. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30(5):421–34.

    Article  Google Scholar 

  6. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012;40(2):502–9.

    Article  Google Scholar 

  7. Rabiee ANS, Hashem MD, Huang M, Dinglas VD, Bienvenu OJ, Turnbull AE, Needham DM. Depressive symptoms after critical illness: a systematic review and meta-analysis. Crit Care Med. 2016;44(9):1744–53.

    Article  Google Scholar 

  8. Carlet J, Thijs LG, Antonelli M, Cassell J, Cox P, Hill N, et al. Challenges in end-of-life care in the ICU. Statement of the 5th international consensus conference in critical care: Brussels, Belgium, April 2003. Intensive Care Med. 2004;30(5):770–84.

    Article  Google Scholar 

  9. Lupu D. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manag. 2010;40(6):899–911.

    Article  Google Scholar 

  10. Nelson JE, Curtis JR, Mulkerin C, Campbell M, Lustbader DR, Mosenthal AC, et al. Choosing and using screening criteria for palliative care consultation in the ICU: a report from the improving palliative care in the ICU (IPAL-ICU) advisory board. Crit Care Med. 2013;41(10):2318–27.

    Article  Google Scholar 

  11. Nelson JE, Mulkerin CM, Adams LL, Pronovost PJ. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care. 2006;15(4):264–71.

    Article  CAS  Google Scholar 

  12. Curtis JR, Treece PD, Nielsen EL, Gold J, Ciechanowski PS, Shannon SE, et al. Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med. 2016;193(2):154–62.

    Article  Google Scholar 

  13. Carson SS, Cox CE, Wallenstein S, et al. Effect of palliative care–led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA. 2016;316(1):51–62.

    Article  CAS  Google Scholar 

  14. White DB, Angus DC, Shields AM, Buddadhumaruk P, Pidro C, Paner C, et al. A randomized trial of a family-support intervention in intensive care units. N Engl J Med. 2018;378(25):2365–75.

    Article  Google Scholar 

  15. Hua M, Ma X, Morrison RS, Li G, Wunsch H. Association between the availability of hospital-based palliative care and treatment intensity for critically ill patients. Ann Am Thorac Soc. 2018;15(9):1067–74.

    Article  Google Scholar 

  16. Campbell ML, Guzman JA. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest. 2003;123(1):266–71.

    Article  Google Scholar 

  17. Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–5.

    Article  Google Scholar 

  18. Braus N, Campbell TC, Kwekkeboom KL, Ferguson S, Harvey C, Krupp AE, et al. Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Med. 2016;42(1):54–62.

    Article  Google Scholar 

  19. Hua MS, Ma X, Li G, Wunsch H. Derivation of data-driven triggers for palliative care consultation in critically ill patients. J Crit Care. 2018;46:79–83.

    Article  Google Scholar 

  20. Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need for palliative care consultation across United States intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428–36.

    Article  Google Scholar 

  21. Wysham NG, Hua M, Hough CL, Gundel S, Docherty SL, Jones DM, et al. Improving ICU-based palliative care delivery: a multicenter, multidisciplinary survey of critical care clinician attitudes and beliefs. Crit Care Med. 2017;45(4):e372–e8.

    Article  Google Scholar 

  22. Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35(2):605–22.

    Article  Google Scholar 

  23. Piderman KM, Marek DV, Jenkins SM, Johnson ME, Buryska JF, Shanafelt TD, et al. Predicting Patients' expectations of hospital chaplains: a multisite survey. Mayo Clin Proc. 2010;85(11):1002–10.

    Article  Google Scholar 

  24. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642–56.

    Article  Google Scholar 

  25. Choi PJ, Curlin FA, Cox CE. “The patient is dying, please call the chaplain”: the activities of chaplains in one medical Center’s intensive care units. J Pain Symptom Manag. 2015;50(4):501–6.

    Article  Google Scholar 

  26. Choi PJ, Curlin FA, Cox CE. Addressing religion and spirituality in the intensive care unit: a survey of clinicians. Palliat Support Care. 2018:1–6.

    Google Scholar 

  27. Welch LC, Teno JM, Mor V. End-of-life care in black and white: race matters for medical care of dying patients and their families. J Am Geriatr Soc. 2005;53(7):1145–53.

    Article  Google Scholar 

  28. Givens JL, Tjia J, Zhou C, Emanuel E, Ash AS. Racial and ethnic differences in hospice use among patients with heart failure. Arch Intern Med. 2010;170(5):427–32.

    Article  Google Scholar 

  29. Zaide GB, Pekmezaris R, Nouryan CN, Mir TP, Sison CP, Liberman T, et al. Ethnicity, race, and advance directives in an inpatient palliative care consultation service. Palliat Support Care. 2013;11(1):5–11.

    Article  Google Scholar 

  30. Reese DJ, Melton E, Ciaravino K. Programmatic barriers to providing culturally competent end-of-life care. Am J Hosp Palliat Care. 2004;21(5):357–64.

    Article  Google Scholar 

  31. Johnson KS, Kuchibhatla M, Tulsky JA. Racial differences in self-reported exposure to information about hospice care. J Palliat Med. 2009;12(10):921–7.

    Article  Google Scholar 

  32. Kish SK, Martin CG, Price KJ. Advance directives in critically ill cancer patients. Crit Care Nurs Clin North Am. 2000;12(3):373–83.

    Article  CAS  Google Scholar 

  33. Ott BB. Advance directives: the emerging body of research. Am J Crit Care. 1999;8(1):514–9.

    Article  CAS  Google Scholar 

  34. Jennings B, editor. Bioethics. Farmington Hills, MI: Gale, a part of Cengage Learning; 2014.

    Google Scholar 

  35. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, et al. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167(5):453–60.

    Article  Google Scholar 

  36. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302–11.

    Article  CAS  Google Scholar 

  37. Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: a framework for goals of care conversations. J Oncol Pract. 2017;13(10):e844–e50.

    Article  Google Scholar 

  38. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005;55(3):164–77.

    Article  Google Scholar 

  39. Smith RC, Smith RC. Patient-centered interviewing: an evidence-based method. Philadelphia: Lippincott Williams & Wilkins; 2002.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Philip Choi

  2. Department of Internal Medicine, Duke University, Durham, NC, USA

    Michael Murn

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  1. Philip Choi
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Correspondence to Philip Choi .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

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Choi, P., Murn, M. (2020). Palliative Care in the ICU. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_107

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  • DOI: https://doi.org/10.1007/978-3-030-26710-0_107

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26709-4

  • Online ISBN: 978-3-030-26710-0

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