A growing body of literature suggests that many patients in intensive care units (ICUs)
have inadequately controlled symptoms near the end of life [
1
,
2
,
3
,
- Desbiens N.A
- Wu A.W
- Broste S.K
- Wenger N.S
- Connors Jr, A.F
- Lynn J
- et al.
Pain and satisfaction with pain control in seriously ill hospitalized adults: findings
from the SUPPORT research investigations. For the SUPPORT investigators. Study to
Understand Prognoses and Preferences for Outcomes and Risks of Treatment.
Crit Care Med. 1996; 24: 1953-1961
4
,
5
]. There is also evidence that the needs of families of ICU patients are incompletely
met [
6
,
7
,
- Azoulay E
- Pochard F
- Chevret S
- Jourdain M
- Bornstain C
- Wernet A
- et al.
Impact of a family information leaflet on effectiveness of information provided to
family members of intensive care unit patients: a multicenter, prospective, randomized,
controlled trial.
Am J Respir Crit Care Med. 2002; 165: 438-442
8
,
9
,
10
], that communication between physicians and families is inadequate [
6
,
8
,
11
,
12
], and that many physicians are ill-prepared to provide optimal care to dying patients
in the ICU [
13
,
14
]. The purposes of this article are to provide an overview of the current state of
palliative care in the ICU, to delineate barriers to high-quality palliative care,
and to highlight recent advances that provide hope for the future of palliative care
in the ICU. We have chosen to focus our discussion on seven aspects of quality care
for dying patients: symptom control, models of medical decision making, withholding
and withdrawing life-sustaining treatment, advance care planning, the physician–patient–family
relationship, palliative care education, and palliative care instruments, protocols,
and future research. These topics have been selected from a review of the literature
on palliative care in the ICU, with special emphasis on a recent report that delineates
key quality indicators for end of life care in the ICU [
[15]
].To read this article in full you will need to make a payment
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