Early Versus Usual Palliative Care Consultation in the Intensive Care Unit

Abstract

Objectives Palliative Medicine involvement in MICU patients have improved length of stay and mortality, but with varying effects on specific patient decision outcomes, such as, advance care planning. These studies have utilized Palliative Medicine later in the hospital or ICU course, with some evidence showing that earlier involvement resulted in better results. The purpose of this study was to evaluate the benefits of early (within 24 hours) palliative care consultation in medical ICU (MICU) patients to clinical and satisfaction outcomes. Methods An unblinded randomized study performed in the MICU in one academic hospital in the USA. Ninety-one adult patients admitted to MICU received a Palliative care medicine consultation within 24 hours as the intervention. Measurements and results Ninety-one patients admitted to the MICU underwent randomization with 50 patients randomly assigned to receive Palliative Medicine consultation and 41 patients randomly assigned to receive standard-of-care based on predefined criteria. The median satisfaction score was 23 points higher for the patients in the intervention group (P < .001). The median length of MICU stay was 5 days shorter in the intervention group compared to the control group (95% CI; 1 day to 18 days, P = .018). Advance care planning was completed in the hospital for 34% of patients in the intervention arm and 12% of patients in the controls arm (absolute risk difference 22%, 95% CI 4% to 37%, P = .016). Conclusion Early Palliative Medicine consultation within 24 hours of MICU admission showed significant benefits to patients by improving satisfaction and decreasing length of stay. This study provides evidence that Palliative Medicine involvement earlier in the course of severe disease is important. Further studies in other types of intensive care units (neurological and Cardiovascular) are necessary to determine their impact.

Curative to palliative care transition challenges in the intensive care unit. A narrative review.

“…10 Similarly, the study by Helgeson et al provided evidence that early palliative care counseling, within 24 hours of admission to the ICU, improved patient satisfaction with significant benefits. 11 Although the evidence suggests that early palliative care involvement during severe illness is essential. Further studies are needed to determine its impact on ICU patients with particular emphasis on outcomes such as quality of life based on patients' perceptions rather than the perceptions of their families.…”

“…In several studies, the provision of palliative care in the ICU has been associated with increased rates of advance care planning, increased use of palliative care facilities, decreased length of stay, and decreased use of non-beneficial life-sustaining treatments. [11][12][13][14][15][16][17] In addition, the study by Ma et al found that routine palliative care can positively influence the care of critically ill patients. In contrast, early palliative care counseling was posihttps://ejournals.epublishing.ekt.gr/index.php/HealthResJ tively associated with more excellent transitions to do-notresuscitate/non-intubation, hospitalization in palliative care facilities, and reduced use of healthcare resources pre-ICU and post-ICU.…”

A systematic review of needs-based triggers for palliative care for early referral of older people with non-cancer conditions

“…Four studies [38,48,51,57] included multiple diseases, three included both cancer and noncancer conditions [38,51,57], and one included both CHF and COPD [48]. Three studies stated general chronic/advanced noncancer populations [46,53,55], and one included intensive care unit (ICU) populations [40].…”

“…All eleven models were composed of multi-components of palliative care intervention, such as symptom management, self-management education of disease, end-of-life discussions, case conferences, documentation, regular home visits, or a telephone hotline. Seven studies [35,38,40,[43][44][45]47] provided inpatient care and six [36,37,39,41,42,46] implemented outpatient palliative care services. Inpatient palliative care services in seven studies were developed based on the standard referral process of the hospital palliative care team or developed for the trial.…”

“…Eight studies included criteria that assess functional or performance status in their eligibility [35,36,40,42,46,51,53,59]. In trials of patients with HF or COPD, the Palliative Performance Scale (PPS) and KCCQ were employed to assess functional status alongside prognosis, symptoms, or QOL [36,51].…”