Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit

Tabibian, Borna E.; Salehani, Arsalaan; Kuhn, Elizabeth N.; Davis, Matthew C.; Shank, Christopher D; Fisher, Winfield S.

doi:10.1089/jpm.2018.0428

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…However other participants stated that families should be a part of the decision making process. This finding is in contrast to studies from Canada and the United States of policies regarding family participation in intensive care unit patient care (Burns et al, 2018;Tabibian et al, 2019).…”

Section: Discussioncontrasting

confidence: 99%

Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

Alshehri

Wolf

Öhlén

et al. 2021

J Nursing Management

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Aim To explore the association of organizational structures when integrating palliative care in intensive care units. Background Palliative care within intensive care settings has been widely recognized as an area requiring improvement when caring for patients and their families. Despite this, intensive care units continue to struggle to integrate palliative care. Methods A qualitative descriptive methodology was used. Data were collected through research interviews with 15 managers and 36 health care professionals working in intensive care. The data were analysed adopting constant comparative analysis. Results This study provides insight into a diverse range of perspectives on organizational structure in the context of facilitation and the challenges posed. Three themes were identified: Do not resuscitate policy as a gateway to palliative care, facilitating family members to enable participation and support and barriers for palliative care in intensive care unit as a result of intensive care organization. Conclusions In fostering a sustainable organizational culture and practice development in intensive care, the findings indicate the need for specific palliative care policies and implementation strategies tailored according to context. Implications for nursing management Management has a responsibility to facilitate dialogue within any multidisciplinary team regarding palliative care and, in particular, to focus on ‘do not resuscitate’ policies as a gateway into this conversation.

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Section: Discussioncontrasting

confidence: 99%

Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

Alshehri

Wolf

Öhlén

et al. 2021

J Nursing Management

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“…23 Their care may also be limited by lack of expert facilitation when translating goals and values to specific care decisions. 24 In addition, we speculate that early decisions not to refer patients to consultative palliative care due to lack of perceived necessity do not account for, and in fact may lead to, delay in referrals. That is, reliance on neurointensivists' assessment alone of whether patients may benefit from palliative care may result in late referral and missed care opportunities.…”

Section: Discussionmentioning

confidence: 88%

Palliative Care Services in the NeuroICU: Opportunities and Persisting Barriers

Morris

Mroz

Popescu

et al. 2021

Am J Hosp Palliat Care

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Background: End-of-life (EOL) supportive care, including palliative and hospice services, is an area of increasing importance in critical care. Neurointensivists face unique challenges in providing timely supportive care to terminally ill patients expected to expire in the NeuroICU. Objective: This study explored the extent of effective utilization of, and recorded barriers to, palliative and hospice services in a dedicated 30-bed NeuroICU at a large academic medical center. Design: A retrospective chart review of patients who expired in the NeuroICU was conducted. The timeline from patient admission to arrival of palliative care services was traced. Qualitative review of chart notes was used to identify barriers to provision of palliative services. Setting: A total of 330 patients expired in the NeuroICU during the study period, including 176 from the neurology and 154 from the neurosurgical service. Results: Across services, 146 expired patients were never referred to palliative care or hospice services. Of those referred, over one-third were referred more than 4 days past admission to the NeuroICU. On average, patients were referred with less than 1 day before expiration. Common barriers to referral for supportive services were documented (e.g., patient expected to expire, family declined service). Conclusions: Despite benefits of palliative care and an in-hospital hospice opportunity, we identified lack of referral, and particularly delays in referral to services as significant barriers. Our study highlights these as missed opportunities for patients and families to receive maximum benefits from these services. Future research should solidify triggers for EOL services in this setting.

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“…19 Palliative care consultations in the neuro-intensive care unit can lead to more frequent code status changes, increased utilization of medications for symptom management, and decreased medical interventions at the end of life. 20 Early identification of patients who may benefit from palliative care consultation and increased To better understand barriers to discharging to hospice, we compared patients who were referred to hospice and successfully discharged to patients who were referred to hospice but ultimately died in the hospital. The sample size was small, but trends can be observed that deserve further study.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice

Dujari

Wei

Kraler

et al. 2023

The Neurohospitalist

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Background and Purpose The Neurology Mortality Review Committee at our institution identified variability in location of death for patients on our inpatient neurology services. Hospice may increase the number of patients dying in their preferred locations. This study aimed to characterize patients who die on inpatient neurology services and explore barriers to discharge to hospice. Methods This retrospective study was completed at a single, quaternary care medical center that is a Level I Trauma Center and Comprehensive Stroke Center. Patients discharged by an inpatient neurology service between 6/2019-1/2021 were identified and electronic medical record review was performed on patients who died in the hospital and who were discharged to hospice. Results 69 inpatient deaths and 74 discharges to hospice occurred during the study period. Of the 69 deaths, 54 occurred following withdrawal of life sustaining treatment (WLST), of which 14 had a referral to hospice placed. There were 88 “hospice-referred” patients and 40 “hospice-eligible” patients. Hospice-referred patients were less likely to require the intensive care unit than hospice-eligible patients. Hospice-referred patients had their code status changed to Do Not Intubate earlier and were more likely to have advanced directives available. Conclusion Our data highlight opportunities for further research to improve discharge to hospice including interhospital transfers, advanced directives, earlier goals of care discussions, palliative care consultations, and increased hospice bed availability. Importantly, it highlights the limitations of using in-hospital mortality as a quality indicator in this patient population.

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Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit

Cited by 13 publications

References 14 publications

Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study

Palliative Care Services in the NeuroICU: Opportunities and Persisting Barriers

Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice

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