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

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.

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

2017 ◽  
Vol 35 (3) ◽  
pp. 384-389 ◽  
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.

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

2019 ◽  
Vol 14 (9) ◽  
pp. 1324-1335 ◽  
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.

scholarly journals Palliative Care in Patients With High-Grade Gliomas in the Neurological Intensive Care Unit

2019 ◽  
Vol 10 (3) ◽  
pp. 163-167
Author(s):  
Jon Rosenberg ◽  
Allie Massaro ◽  
James Siegler ◽  
Stacey Sloate ◽  
Matthew Mendlik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
High Grade ◽  
Neurological Intensive Care Unit ◽  
Code Status ◽  
Neurological Intensive Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Background: Palliative care improves quality of life in patients with malignancy; however, it may be underutilized in patients with high-grade gliomas (HGGs). We examined the practices regarding palliative care consultation (PCC) in treating patients with HGGs in the neurological intensive care unit (NICU) of an academic medical center. Methods: We conducted a retrospective cohort study of patients admitted to the NICU from 2011 to 2016 with a previously confirmed histopathological diagnosis of HGG. The primary outcome was the incidence of an inpatient PCC. We also evaluated the impact of PCC on patient care by examining its association with prespecified secondary outcomes of code status amendment to do not resuscitate (DNR), discharge disposition, 30-day mortality, and 30-day readmission rate, length of stay, and place of death. Results: Ninety (36% female) patients with HGGs were identified. Palliative care consultation was obtained in 16 (18%) patients. Palliative care consultation was associated with a greater odds of code status amendment to DNR (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 5.01-65.73), which remained significant after adjustment for confounders (OR: 27.20, 95% CI: 5.49-134.84), a greater odds of discharge to hospice (OR: 24.93, 95% CI: 6.48-95.88), and 30-day mortality (OR: 6.40, 95% CI: 1.96-20.94). Conclusion: In this retrospective study of patients with HGGs admitted to a university-based NICU, PCC was seen in a minority of the sample. Palliative care consultation was associated with code status change to DNR and hospice utilization. Further study is required to determine whether these findings are generalizable and whether interventions that increase PCC utilization are associated with improved quality of life and resource allocation for patients with HGGs.

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

2020 ◽  
Vol 30 ◽  
pp. 16-19
Author(s):  
Ifa Hafifah ◽  
Syamsul Arifin ◽  
Dhemes Alin ◽  
Isnawati
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care

Health-related quality-of-life among survivors of acute kidney injury in the intensive care unit: a systematic review

2015 ◽  
Vol 42 (2) ◽  
pp. 137-146 ◽  
Author(s):  
Pierre-Marc Villeneuve ◽  
Edward G. Clark ◽  
Lindsey Sikora ◽  
Manish M. Sood ◽  
Sean M. Bagshaw
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

Effects of prolonged intensive care unit stay on quality of life and long-term survival after transthoracic esophageal resection

2006 ◽  
Vol 34 (2) ◽  
pp. 354-362 ◽  
Author(s):  
H A. Cense ◽  
J B. F. Hulscher ◽  
A G. E. M. de Boer ◽  
D A. Dongelmans ◽  
H W. Tilanus ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Esophageal Resection ◽  
Term Survival ◽  
Long Term Survival
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