Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units

Creutzfeldt, Claire J.; Wunsch, Hannah; Curtis, J. Randall; Hua, May

doi:10.1007/s12028-015-0143-8

Cited by 33 publications

(16 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients are admitted to ICU because of profound and complex illness(es), and there is often uncertainty about prognosis indicating the need for both curative and comfort measures. Our findings support the proposals of Mosenthal et al and others, for integration of palliative care into critical care, [ 25 ] involving patients and relatives early in decisions where possible [ 5 , 26 ]. They also bolster the work of Levin et al, which recommends skilled communication and family meetings [ 27 ].…”

Section: Discussionsupporting

confidence: 91%

The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

et al. 2015

View full text Add to dashboard Cite

BackgroundWith increasingly intensive treatments and population ageing, more people face complex treatment and care decisions. We explored patterns of the decision-making processes during critical care, and sources of conflict and resolution.MethodsEthnographic study in two Intensive Care Units (ICUs) in an inner city hospital comprising: non-participant observation of general care and decisions, followed by case studies where treatment limitation decisions, comfort care and/or end of life discussions were occurring. These involved: semi-structured interviews with consenting families, where possible, patients; direct observations of care; and review of medical records.ResultsInitial non-participant observation included daytime, evenings, nights and weekends. The cases were 16 patients with varied diagnoses, aged 19-87 years; 19 family members were interviewed, aged 30-73 years. Cases were observed for <1 to 156 days (median 22), depending on length of ICU admission. Decisions were made serially over the whole trajectory, usually several days or weeks. We identified four trajectories with distinct patterns: curative care from admission; oscillating curative and comfort care; shift to comfort care; comfort care from admission. Some families considered decision-making a negative concept and preferred uncertainty. Conflict occurred most commonly in the trajectories with oscillating curative and comfort care. Conflict also occurred inside clinical teams. Families were most often involved in decision-making regarding care outcomes and seemed to find it easier when patients switched definitively from curative to comfort care. We found eight categories of decision-making; three related to the care outcomes (aim, place, response to needs) and five to the care processes (resuscitation, decision support, medications/fluids, monitoring/interventions, other specialty involvement).ConclusionsDecision-making in critical illness involves a web of discussions regarding the potential outcomes and processes of care, across the whole disease trajectory. When measures oscillate between curative and comfort there is greatest conflict. This suggests a need to support early communication, especially around values and preferred care outcomes, from which other decisions follow, including DNAR. Offering further support, possibly with expert palliative care, communication, and discussion of ‘trial of treatment’ may be beneficial at this time, rather than waiting until the ‘end of life’.

show abstract

Section: Discussionsupporting

confidence: 91%

The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

et al. 2015

View full text Add to dashboard Cite

show abstract

“…38,39 Retrospective research in the neurology ICU has similarly used these triggers to define the prevalence of palliative care needs for critically ill neurologic patients. 40 Identification of patient-specific triggers for serious illness conversations may help facilitate initiation of goals of care conversations by providers.…”

Section: Key Palliative Care Skills For the Neurologistmentioning

confidence: 99%

Neuropalliative Care: A Practical Guide for the Neurologist

Brizzi

Creutzfeldt

2018

Semin Neurol

View full text Add to dashboard Cite

Neuropalliative care is a new and growing field within neurology that focuses on improving the quality of life of patients with serious neurologic illnesses. While specialty-level palliative care training is available to interested neurologists, all neurologists can strive to provide primary palliative care for their patients. In this review, we will describe the scope of neuropalliative care, define patient populations who may benefit from palliative care, and explore the communication and symptom management skills essential to palliative care delivery.

show abstract

“…7 Thus, substantial research efforts within neurology have focused on effective and consistent communication, and palliative care interventions for patients and their families. 4,[8][9][10][11] However, there is a paucity of data exploring the basic demographic, social, medical, and functional variables that may influence decisions to pursue aggressive versus limited treatment in nontraumatic intracranial hemorrhage. We sought to fill this void and examine the relationship between demographic, social, medical and functional variables and code status on admission and at discharge for these patients.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage

Lillemoe

Lord

Torres

et al. 2019

The Neurohospitalist

View full text Add to dashboard Cite

Background: We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage. Methods: We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status. Results: Of 88 patients who met inclusion criteria, 6 (7%) were do not resuscitate (DNR) on admission (aDNR). Do not resuscitate on admission patients were significantly older than those who were full code on admission ( P = 0.04). There was no significant difference between admission code status and sex, marital status, active cancer, premorbid mRS, admission Glasgow Coma scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, or bleed severity. At discharge, 66 (75%) patients were full code (dFULL), 11 (13%) were DNR (dDNR), and 11 (13%) were comfort care. African American and Hispanic patients were significantly more likely to be dFULL than Asian or white patients ( P = .01) and less likely to be seen by palliative care ( P = .004). Patients with less aggressive code status had higher median APACHE II scores ( P = .008) and were more likely to have active cancer ( P = .06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity. Conclusions: Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.

show abstract

Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units

Cited by 33 publications

References 20 publications

The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

Neuropalliative Care: A Practical Guide for the Neurologist

Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage

Contact Info

Product

Resources

About