Patterns of palliative care service consultation in a sample of critically ill ICU patients at high risk of dying

Abstract

Objective Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying. Background Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes. Methods From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 hours of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty consultation. Results About half (773/1440[54%]) were at high risk of dying or died, 73(9.4%) of whom received palliative care consultation. On average, referral occurred after 62% of the ICU stay had elapsed. Primary reason for consult was clarification of goals of care (52/73[72.2%]). Conclusions Among MV ICU patients at high risk of dying, palliative care service consultation occurs late and infrequently, suggesting a role for earlier palliative care.

Health Literacy of Surrogates and Communication Issues in Palliative Care Conversations in Critical Care

“…45 In this review, conversations continue to be late and infrequent. 46 Future studies should aim to capture the effects of palliative care conversations on surrogate decision-makers during initial stages of an admission. There were differences between what the clinician attempted to communicate and what the surrogate understood.…”

Views of intensive care physical therapists on palliative care

“…Eleven physical therapists participated in the study. To ensure their anonymity, the study participants were identified with a reference code beginning with PT (physical therapist) followed by a number representing the order in which they were interviewed (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11).…”

“…1 Nevertheless, despite this, when assistance reports to patients in palliative care (PC), there is a lot of contradiction concerning the conduct to be performed, in the face of complex questions regarding threats to the patient's comfort and dignity. 2,3 Therefore, it is necessary to discuss ways to promote care for palliative patients and their families. 4 Despite the changes in the panorama of assistance to patients in PC, there is still a theoretical gap regarding the understanding and perception of physiotherapists concerning the concept and their professional skills in the face of the needs of patients in internal PC in an ICU.…”

Utilization and Delivery of Specialty Palliative Care in the ICU: Insights from the Palliative Care Quality Network

“…1 In the intensive care unit (ICU), many PC needs are apparent including: communication of prognosis and diagnosis; complex patient, family and surrogate interactions; difficult decision making and goals-of-care (GOC) conversations; complex symptom management; and end-of-life (EOL) care often involving withdrawal of interventions. 2,3 Despite estimates that a large subset of ICU patients would benefit from PC consultation, 4 specialty PC remains underutilized in the ICU setting overall 5 and for the subset of patients who die in the ICU. 6 PC interventions in the critically ill have been associated with reduced subsequent ICU admissions and reduced ICU length of stay.…”