Quality of palliative care in intensive care unit “X” Hospital Indonesia

145 Background: Despite the growing palliative care movement, most admissions still occur in Intensive Care Units. The aim of this study was to determine the frequency of palliative care patients admitted in an ICU and assessed their outcomes. Methods: This prospective study was conducted in a tertiary private hospital, in an adult medical-surgical ICU with 22-bed in São Paulo, Brazil. Patients or their family member with ICU stay ≥ 48 hours were invited to participate. They were excluded if they had no conditions to answer the questionnaire or if they refuse to participate. During ICU stay we analyzed through the medical records and questionnaire their clinical condition and their oncologic status. We called them by telephonic assessment to assess their survival. Results: From March 2011 to March 2013 a total of 576 ICU patients were analyzed; of these, 280 were oncologic patients and 95 were palliative care. Of total, the majority was male gender (57.8%), median age was 67[54-79] years, SAPS III score was 54±18.4 points, SOFA was 3.1±3.0 and ICU Length of stay (LOS) was 9.0±11.3 days. ICU mortality was 16.5%, 1-month mortality was 22% and 3-months cumulative mortality was 28.6%. We could observe that palliative care patients were in majority cancer patients (75%vs 43.4%,p<0.001), with metastatic disease(81.7 vs 36.3, p<0.001), had greater mean time of initial diagnosis(3.21±3.7 vs 2.17±2.5, p=0.009), had greater ICU LOS (14.2±16.2 days vs 7.96±9.8, p<0.001) greater mean SAPS III (68.5±16.0 vs p<0.001) and SOFA (4.81±3.2 vs 2.81±2.8, p<0.001) when compared with non palliative patients care. They also needed more mechanical ventilation (50.0%vs32.6%, p=0.001), tracheotomy (11.6%vs 5.0%,p=0.014) and vasopressors (54.7% vs 36.8,p=0.001). The ICU mortality was greater (32.6% vs 6.8%, p<0.001), 1-month (60.0% vs 14.0%, p<0.001) and 3-months (73.5% vs 19.1%). Conclusions: Palliative care suffers most in Intensive Care Unit and we observed a high mortality at 3-months after ICU discharge. We recommend more discussions before palliative care patient’s admissions in ICU to better provide them quality of life.

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Palliative and End-of-Life Care in the Intensive Care Unit

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0138 ◽

2019 ◽

pp. 997-1000

Author(s):

Maisha T. Robinson

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Palliative Medicine ◽

Life Care ◽

Patient Centered ◽

Consultative Service ◽

Icu Physicians

Palliative medicine is the specialty that focuses on improving the quality of life for patients and families when the patients have serious or advanced medical conditions. The approach to care is patient centered and goal oriented. It can be performed at any stage of illness with or without a palliative medicine consultative service. All clinicians, including intensive care unit (ICU) physicians, who care for patients with serious or advanced illnesses should be able to provide adequate palliative care.

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Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01560219 ◽

2019 ◽

Vol 14 (9) ◽

pp. 1324-1335 ◽

Cited By ~ 1

Author(s):

Claire A. Richards ◽

Chuan-Fen Liu ◽

Paul L. Hebert ◽

Mary Ersek ◽

Melissa W. Wachterman ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Acute Dialysis ◽

Palliative Care Consultation ◽

Maintenance Dialysis

Background and objectivesLittle is known about the quality of end-of-life care for patients with advanced CKD. We describe the relationship between patterns of end-of-life care and dialysis treatment with family-reported quality of end-of-life care in this population.Design, setting, participants, & measurementsWe designed a retrospective observational study among a national cohort of 9993 veterans with advanced CKD who died in Department of Veterans Affairs facilities between 2009 and 2015. We used logistic regression to evaluate associations between patterns of end-of-life care and receipt of dialysis (no dialysis, acute dialysis, maintenance dialysis) with family-reported quality of end-of-life care.ResultsOverall, 52% of cohort members spent ≥2 weeks in the hospital in the last 90 days of life, 34% received an intensive procedure, and 47% were admitted to the intensive care unit, in the last 30 days, 31% died in the intensive care unit, 38% received a palliative care consultation in the last 90 days, and 36% were receiving hospice services at the time of death. Most (55%) did not receive dialysis, 12% received acute dialysis, and 34% received maintenance dialysis. Patients treated with acute or maintenance dialysis had more intensive patterns of end-of-life care than those not treated with dialysis. After adjustment for patient and facility characteristics, receipt of maintenance (but not acute) dialysis and more intensive patterns of end-of-life care were associated with lower overall family ratings of end-of-life care, whereas receipt of palliative care and hospice services were associated with higher overall ratings. The association between maintenance dialysis and overall quality of care was attenuated after additional adjustment for end-of-life treatment patterns.ConclusionsAmong patients with advanced CKD, care focused on life extension rather than comfort was associated with lower family ratings of end-of-life care regardless of whether patients had received dialysis.

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Clinical implications and quality of evidence in metaanalysis about effects of palliative care in critically ill patients in the intensive care unit

Palliative & Supportive Care ◽

10.1017/s1478951516001036 ◽

2017 ◽

Vol 15 (5) ◽

pp. 513-515 ◽

Cited By ~ 1

Author(s):

Alex Wonnaparhown ◽

Amaan Shafi ◽

Xibei Liu ◽

Angela H. Villamagna ◽

Michael Lee ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Implications ◽

Quality Of Evidence

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Speaking a Different Language: A Qualitative Analysis Comparing Language of Palliative Care and Pediatric Intensive Care Unit Physicians

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117700101 ◽

2017 ◽

Vol 35 (3) ◽

pp. 384-389 ◽

Cited By ~ 4

Author(s):

Anne G. Ciriello ◽

Zoelle B. Dizon ◽

Tessie W. October

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Medical Information ◽

Pediatric Intensive Care ◽

Icu Physicians ◽

Pediatric Icu

Background: Family conferences in the pediatric intensive care unit (ICU) often include palliative care (PC) providers. We do not know how ICU communication differs when the PC team is present. Aim: To compare language used by PC team and ICU physicians during family conferences. Design: A retrospective cohort review of ICU family conferences with and without the PC team. Setting: Forty-four bed pediatric ICU in a tertiary medical center. Participants: Nine ICU physicians and 4 PC providers who participated in 18 audio-recorded family conferences. Results: Of the 9 transcripts without the PC team, we identified 526 ICU physician statements, generating 10 thematic categories. The most common themes were giving medical information and discussing medical options. Themes unique to ICU physicians included statements of hopelessness, insensitivity, and “health-care provider challenges.” Among the 9 transcripts with the PC team, there were 280 statements, generating 10 thematic categories. Most commonly, the PC team offered statements of support, giving medical information, and quality of life. Both teams promoted family engagement by soliciting questions; however, the PC team was more likely to use open-ended questions, offer support, and discuss quality of life. Conclusion: Pediatric ICU physicians spend more time giving medical information, whereas the PC team more commonly offers emotional support. The addition of the PC team to ICU family conferences may provide a balanced approach to communication.

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