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01-12-2021 | Care | Systematic Review

Palliative care interventions in intensive care unit patients

Authors: Victoria Metaxa, Despina Anagnostou, Savvas Vlachos, Nishkantha Arulkumaran, Sherihane Bensemmane, Ingeborg van Dusseldorp, Rebecca A. Aslakson, Judy E. Davidson, Rik T. Gerritsen, Christiane Hartog, J. Randall Curtis

Published in: Intensive Care Medicine | Issue 12/2021

Abstract

Purpose

The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear.

Methods

We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries.

Results

Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies.

Conclusion

Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.

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Vincent JL, Marshall JC, Namendys-Silva SA, François B, Martin-Loeches I, Lipman J, Reinhart K, Antonelli M, Pickkers P, Njimi H et al (2014) Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2(5):380–386PubMedCrossRef

Sprung CL, Ricou B, Hartog CS, Maia P, Mentzelopoulos SD, Weiss M, Levin PD, Galarza L, de la Guardia V, Schefold JC et al (2019) Changes in end-of-life practices in European Intensive Care Units from 1999 to 2016. JAMA 322(17):1692–1704PubMedPubMedCentralCrossRef

Schmidt M, Azoulay E (2012) Having a loved one in the ICU: the forgotten family. Curr Opin Crit Care 18(5):540–547PubMedCrossRef

Puntillo KA, Arai S, Cohen NH, Gropper MA, Neuhaus J, Paul SM, Miaskowski C (2010) Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 38(11):2155–2160PubMedPubMedCentralCrossRef

Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinová K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B et al (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180(9):853–860PubMedCrossRef

Azoulay E, Chevret S, Leleu G, Pochard F, Barboteu M, Adrie C, Canoui P, Le Gall JR, Schlemmer B (2000) Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 28(8):3044–3049PubMedCrossRef

Institute of Medicine Committee on Quality of Health Care in A. In: Crossing the quality chasm: a new health system for the 21st century. National Academies Press (US), Washington (DC). Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.

World Health Organization (2019) Palliative care for noncommunicable diseases: a global snapshot. WHO REFERENCE NUMBER: WHO/NMH/NVI/19.7. World Health Organization, Geneva

Ferrell BR, Twaddle ML, Melnick A, Meier DE (2018) National consensus project clinical practice guidelines for quality palliative care guidelines, 4th edition. J Palliat Med 21(12):1684–1689PubMedCrossRef

10.

Lynch T, Connor S, Clark D (2013) Mapping levels of palliative care development: a global update. J Pain Symptom Manag 45(6):1094–1106CrossRef

11.

Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, Hoydich ZP, Ikejiani DZ, Klein-Fedyshin M, Zimmermann C et al (2016) Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA 316(20):2104–2114PubMedPubMedCentralCrossRef

12.

Edwards JD, Voigt LP, Nelson JE (2017) Ten key points about ICU palliative care. Intensive Care Med 43(1):83–85PubMedCrossRef

13.

Aslakson RA, Curtis JR, Nelson JE (2014) The changing role of palliative care in the ICU. Crit Care Med 42(11):2418–2428PubMedPubMedCentralCrossRef

14.

Metaxa V, Anagnostou D, Vlachos S, Arulkumaran N, van Dusseldorp I, Bensemmane S, Aslakson R, Davidson JE, Gerritsen R, Hartog C et al (2019) Palliative care interventions in intensive care unit patients—a systematic review protocol. Syst Rev 8(1):148PubMedPubMedCentralCrossRef

15.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71PubMedPubMedCentralCrossRef

16.

Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Cox CE, Wunsch H, Wickline MA, Nunnally ME et al (2017) Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 45(1):103–128PubMedCrossRef

17.

Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ (2014) Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med 17(2):219–235PubMedPubMedCentralCrossRef

18.

Clarke EB, Curtis JR, Luce JM, Levy M, Danis M, Nelson J, Solomon MZ (2003) Quality indicators for end-of-life care in the intensive care unit. Crit Care Med 31(9):2255–2262PubMedCrossRef

19.

Aslakson RA, Bridges JF (2013) Assessing the impact of palliative care in the intensive care unit through the lens of patient-centered outcomes research. Curr Opin Crit Care 19(5):504–510PubMedCrossRef

20.

Sterne JACSJ, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clin Res Ed) 366:l4898

21.

Sterne JACHM, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JPT (2016) ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions. BMJ 355:i4919PubMedPubMedCentralCrossRef

22.

Schulz R, Czaja SJ, McKay JR, Ory MG, Belle SH (2010) Intervention taxonomy (ITAX): describing essential features of interventions. Am J Health Behav 34(6):811–821PubMedPubMedCentralCrossRef

23.

Ahrens T, Yancey V, Kollef M (2003) Improving family communications at the end of life: implications for length of stay in the intensive care unit and resource use. Am J Crit Care 12(4):317–323PubMedCrossRef

24.

Burns JP, Mello MM, Studdert DM, Puopolo AL, Truog RD, Brennan TA (2003) Results of a clinical trial on care improvement for the critically ill. Crit Care Med 31(8):2107–2117PubMedCrossRef

25.

Kaufer M, Murphy P, Barker K, Mosenthal A (2008) Family satisfaction following the death of a loved one in an inner city MICU. Am J Hosp Palliat Care 25(4):318–325PubMedCrossRef

26.

Lamba S, Murphy P, McVicker S, Harris Smith J, Mosenthal AC (2012) Changing end-of-life care practice for liver transplant service patients: structured palliative care intervention in the surgical intensive care unit. J Pain Symptom Manag 44(4):508–519CrossRef

27.

Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G et al (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356(5):469–478PubMedCrossRef

28.

Mosenthal AC, Murphy PA, Barker LK, Lavery R, Retano A, Livingston DH (2008) Changing the culture around end-of-life care in the trauma intensive care unit. J Trauma 64(6):1587–1593PubMed

29.

Lilly CM, De Meo DL, Sonna LA, Haley KJ, Massaro AF, Wallace RF, Cody S (2000) An intensive communication intervention for the critically ill. Am J Med 109(6):469–475PubMedCrossRef

30.

Lilly CM, Sonna LA, Haley KJ, Massaro AF (2003) Intensive communication: four-year follow-up from a clinical practice study. Crit Care Med 31(5 Suppl):S394-399PubMedCrossRef

31.

Mun E, Umbarger L, Ceria-Ulep C, Nakatsuka C (2018) Palliative care processes embedded in the ICU workflow may reserve palliative care teams for refractory cases. Am J Hosp Palliat Care 35(1):60–65PubMedCrossRef

32.

Quenot JP, Rigaud JP, Prin S, Barbar S, Pavon A, Hamet M, Jacquiot N, Blettery B, Hervé C, Charles PE et al (2012) Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices. Intensive Care Med 38(1):55–61PubMedCrossRef

33.

Quenot JP, Rigaud JP, Prin S, Barbar S, Pavon A, Hamet M, Jacquiot N, Blettery B, Hervé C, Charles PE et al (2012) Impact of an intensive communication strategy on end-of-life practices in the intensive care unit. Intensive Care Med 38(1):145–152PubMedCrossRef

34.

White DB, Angus DC, Shields AM, Buddadhumaruk P, Pidro C, Paner C, Chaitin E, Chang CCH, Pike F, Weissfeld L et al (2018) A randomized trial of a family-support intervention in intensive care units. N Engl J Med 378(25):2365–2375PubMedCrossRef

35.

Carson SS, Cox CE, Wallenstein S, Hanson LC, Danis M, Tulsky JA, Chai E, Nelson JE (2016) Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 316(1):51–62PubMedPubMedCentralCrossRef

36.

Hatler CW, Grove C, Strickland S, Barron S, White BD (2012) The effect of completing a surrogacy information and decision-making tool upon admission to an intensive care unit on length of stay and charges. J Clin Ethics 23(2):129–138PubMedCrossRef

37.

Penrod JD, Luhrs CA, Livote EE, Cortez TB, Kwak J (2011) Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit. J Pain Symptom Manag 42(5):668–671CrossRef

38.

Wessman BT, Sona C, Schallom M (2017) Improving caregivers’ perceptions regarding patient goals of care/end-of-life issues for the multidisciplinary critical care team. J Intensive Care Med 32(1):68–76PubMedCrossRef

39.

Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE, Back AL, Rubenfeld GD, Engelberg RA (2011) Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med 183(3):348–355PubMedCrossRef

40.

Curtis JR, Treece PD, Nielsen EL, Downey L, Shannon SE, Braungardt T, Owens D, Steinberg KP, Engelberg RA (2008) Integrating palliative and critical care: evaluation of a quality-improvement intervention. Am J Respir Crit Care Med 178(3):269–275PubMedPubMedCentralCrossRef

41.

Hall RI, Rocker GM, Murray D (2004) Simple changes can improve conduct of end-of-life care in the intensive care unit. Can J Anaesth 51(6):631–636PubMedCrossRef

42.

Hansen L, Goodell TT, Dehaven J, Smith M (2009) Nurses’ perceptions of end-of-life care after multiple interventions for improvement. Am J Crit Care 18(3):263–271PubMedCrossRef

43.

Wysham NG, Mularski RA, Schmidt DM, Nord SC, Louis DL, Shuster E, Curtis JR, Mosen DM (2014) Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy. J Crit Care 29(3):450–454PubMedCrossRef

44.

Constantine L (2016) Evaluation of a multifaceted educational intervention to improve palliative care in the intensive care unit: adopting the care and communication bundle. J Hospice Palliat Nurs 18(6):519–525CrossRef

45.

Curtis JR, Engelberg RA, Wenrich MD, Nielsen EL, Shannon SE, Treece PD, Tonelli MR, Patrick DL, Robins LS, McGrath BB et al (2002) Studying communication about end-of-life care during the ICU family conference: development of a framework. J Crit Care 17(3):147–160PubMedCrossRef

46.

Hales BM, Hawryluck L (2008) An interactive educational workshop to improve end of life communication skills. J Contin Educ Health Prof 28(4):241–248PubMedCrossRef

47.

Anderson WG, Puntillo K, Cimino J, Noort J, Pearson D, Boyle D, Grywalski M, Meyer J, O’Neil-Page E, Cain J et al (2017) Palliative care professional development for critical care nurses: a multicenter program. Am J Crit Care 26(5):361–371PubMedCrossRef

48.

Creutzfeldt CJ, Engelberg RA, Healey L, Cheever CS, Becker KJ, Holloway RG, Curtis JR (2015) Palliative care needs in the neuro-ICU. Crit Care Med 43(8):1677–1684PubMedPubMedCentralCrossRef

49.

Jenko M, Adams JA, Johnson CM, Thompson JA, Bailey DE Jr (2015) Facilitating palliative care referrals in the intensive care unit: a pilot project. Dimens Crit Care Nurs 34(6):329–339PubMedCrossRef

50.

Sihra L, Harris M, O’Reardon C (2011) Using the improving palliative care in the intensive care unit (IPAL-ICU) project to promote palliative care consultation. J Pain Symptom Manag 42(5):672–675CrossRef

51.

Walker KA, Mayo RL, Camire LM, Kearney CD (2013) Effectiveness of integration of palliative medicine specialist services into the intensive care unit of a community teaching hospital. J Palliat Med 16(10):1237–1241PubMedCrossRef

52.

Finkelstein M, Goldstein NE, Horton JR, Eshak D, Lee EJ, Kohli-Seth R (2016) Developing triggers for the surgical intensive care unit for palliative care integration. J Crit Care 35:7–11PubMedCrossRef

53.

Mun E, Ceria-Ulep C, Umbarger L, Nakatsuka C (2016) Trend of decreased length of stay in the intensive care unit (ICU) and in the hospital with palliative care integration into the ICU. Perm J 20(4):16–036PubMedPubMedCentralCrossRef

54.

Gutierrez C, Hsu W, Ouyang Q, Yao H, Pollack S, Pan CX (2014) Palliative care intervention in the intensive care unit: comparing outcomes among seriously ill Asian patients and those of other ethnicities. J Palliat Care 30(3):151–157PubMedCrossRef

55.

Braus N, Campbell TC, Kwekkeboom KL, Ferguson S, Harvey C, Krupp AE, Lohmeier T, Repplinger MD, Westergaard RP, Jacobs EA et al (2016) Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Med 42(1):54–62PubMedCrossRef

56.

Villarreal D, Restrepo MI, Healy J, Howard B, Tidwell J, Ross J, Hartronft S, Jawad M, Sanchez-Reilly S, Reed K et al (2011) A model for increasing palliative care in the intensive care unit: enhancing interprofessional consultation rates and communication. J Pain Symptom Manag 42(5):676–679CrossRef

57.

McAndrew NS, McCracken C, Szabo A, Narayanan B, Peltier W, Leske J (2020) Evaluating the outcomes of an organizational initiative to expand end-of-life resources in intensive care units with palliative support tools and floating hospice. Dimens Crit Care Nurs 39(4):219–235PubMedCrossRef

58.

O’Mahony S, Johnson TJ, Amer S, McHugh ME, McHenry J, Fosler L, Kvetan V (2017) Integration of palliative care advanced practice nurses into intensive care unit teams. Am J Hosp Palliat Care 34(4):330–334PubMedCrossRef

59.

Higginson IJ, Koffman J, Hopkins P, Prentice W, Burman R, Leonard S, Rumble C, Noble J, Dampier O, Bernal W et al (2013) Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty. BMC Med 11:213PubMedPubMedCentralCrossRef

60.

Campbell ML, Guzman JA (2004) A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Crit Care Med 32(9):1839–1843PubMedCrossRef

61.

Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE (2007) Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 35(6):1530–1535PubMedCrossRef

62.

Schneiderman LJ, Gilmer T, Teetzel HD (2000) Impact of ethics consultations in the intensive care setting: a randomized, controlled trial. Crit Care Med 28(12):3920–3924PubMedCrossRef

63.

Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, Briggs KB, Komatsu GI, Goodman-Crews P, Cohn F et al (2003) Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 290(9):1166–1172PubMedCrossRef

64.

Curtis JR, Treece PD, Nielsen EL, Gold J, Ciechanowski PS, Shannon SE, Khandelwal N, Young JP, Engelberg RA (2016) Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med 193(2):154–162PubMedPubMedCentralCrossRef

65.

Lustbader D, Pekmezaris R, Frankenthaler M, Walia R, Smith F, Hussain E, Napolitano B, Lesser M (2011) Palliative medicine consultation impacts DNR designation and length of stay for terminal medical MICU patients. Palliat Support Care 9(4):401–406PubMedCrossRef

66.

Pavlish CL, Henriksen J, Brown-Saltzman K, Robinson EM, Warda US, Farra C, Chen B, Jakel P (2020) A Team-based early action protocol to address ethical concerns in the intensive care unit. Am J Crit Care 29(1):49–61PubMedCrossRef

67.

Campbell ML, Guzman JA (2003) Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 123(1):266–271PubMedCrossRef

68.

Ravakhah K, Chideme-Munodawafa A, Nakagawa S (2010) Financial outcomes of palliative care services in an intensive care unit. J Palliat Med 13(1):7PubMedCrossRef

69.

Shelton W, Moore CD, Socaris S, Gao J, Dowling J (2010) The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit. Crit Care Med 38(5):1315–1320PubMedCrossRef

70.

Zalenski RJ, Jones SS, Courage C, Waselewsky DR, Kostaroff AS, Kaufman D, Beemath A, Brofman J, Castillo JW, Krayem H et al (2017) Impact of palliative care screening and consultation in the ICU: a multihospital quality improvement project. J Pain Symptom Manag 53(1):5-12.e13CrossRef

71.

Hsu-Kim C, Friedman T, Gracely E, Gasperino J (2015) Integrating palliative care into critical care: a quality improvement study. J Intensive Care Med 30(6):358–364PubMedCrossRef

72.

Zern EK, Young MN, Triana T, Xu M, Holmes B, Borges N, McPherson JA, Karlekar MB (2017) Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: a retrospective analysis. Resuscitation 112:22–27PubMedCrossRef

73.

Dowdy MD, Robertson C, Bander JA (1998) A study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stay. Crit Care Med 26(2):252–259PubMedCrossRef

74.

Ma J, Chi S, Buettner B, Pollard K, Muir M, Kolekar C, Al-Hammadi N, Chen L, Kollef M, Dans M (2019) Early palliative care consultation in the medical ICU: a cluster randomized crossover trial. Crit Care Med 47(12):1707–1715PubMedPubMedCentralCrossRef

75.

McCannon JB, O’Donnell WJ, Thompson BT, El-Jawahri A, Chang Y, Ananian L, Bajwa EK, Currier PF, Parikh M, Temel JS et al (2012) Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study. J Palliat Med 15(12):1382–1387PubMedPubMedCentralCrossRef

76.

McCormick AJ, Curtis JR, Stowell-Weiss P, Toms C, Engelberg R (2010) Improving social work in intensive care unit palliative care: results of a quality improvement intervention. J Palliat Med 13(3):297–304PubMedPubMedCentralCrossRef

77.

Treece PD, Engelberg RA, Crowley L, Chan JD, Rubenfeld GD, Steinberg KP, Curtis JR (2004) Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med 32(5):1141–1148PubMedCrossRef

78.

White DB, Angus DC, Shields A, Pidro C, Paner C, Buddadhumaruk P, Chang CH, Kahn JM, Kowinsky A, Martin S et al (2018) A stepped wedge randomized controlled trial of a pragmatic, nurse-led intervention to support surrogate decision makers in ICUs. Am J Respir Crit Care Med 197(MeetingAbstracts)

79.

Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR (2015) Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med 43(5):1102–1111PubMedPubMedCentralCrossRef

80.

Scheunemann LP, McDevitt M, Carson SS, Hanson LC (2011) Randomized, controlled trials of interventions to improve communication in intensive care: a systematic review. Chest 139(3):543–554PubMedCrossRef

81.

Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, Curtis JR, Lustbader DR, Mulkerin C, Puntillo KA et al (2010) Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med 38(9):1765–1772PubMedPubMedCentralCrossRef

82.

Lau BD, Aslakson RA, Wilson RF, Fawole OA, Apostol CC, Martinez KA, Vollenweider D, Bass EB, Dy SE (2014) Methods for improving the quality of palliative care delivery: a systematic review. Am J Hosp Palliat Care 31(2):202–210PubMedCrossRef

83.

Price DM, Strodtman L, Montagnini M, Smith HM, Miller J, Zybert J, Oldfield J, Policht T, Ghosh B (2017) Palliative and end-of-life care education needs of nurses across inpatient care settings. J Contin Educ Nurs 48(7):329–336PubMedCrossRef

84.

Flannery L, Ramjan LM, Peters K (2016) End-of-life decisions in the Intensive Care Unit (ICU)—exploring the experiences of ICU nurses and doctors—a critical literature review. Aust Crit Care 29(2):97–103PubMedCrossRef

85.

Griffiths I (2019) What are the challenges for nurses when providing end-of-life care in intensive care units? Br J Nurs 28(16):1047–1052PubMedCrossRef

86.

Future nurse: standards of proficiency for registered nurses

87.

People LAftCoD (2014) One chance to get it right. In. Edited by Government LU. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/323188/One_chance_to_get_it_right.pdf. Accessed 5 July 2021

88.

Nelson JE, Mulkerin CM, Adams LL, Pronovost PJ (2006) Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care 15(4):264–271PubMedPubMedCentralCrossRef

89.

Bakitas M, Dionne-Odom JN, Kamal A, Maguire JM (2015) Priorities for evaluating palliative care outcomes in intensive care units. Crit Care Nurs Clin N Am 27(3):395–411CrossRef

90.

Fassier T, Lautrette A, Ciroldi M, Azoulay E (2005) Care at the end of life in critically ill patients: the European perspective. Curr Opin Crit Care 11(6):616–623PubMedCrossRef

91.

Woitha K, Garralda E, Martin-Moreno JM, Clark D, Centeno C (2016) Ranking of palliative care development in the countries of the European Union. J Pain Symptom Manag 52(3):370–377CrossRef

92.

Pivodic L, Pardon K, Van den Block L, Van Casteren V, Miccinesi G, Donker GA, Alonso TV, Alonso JL, Aprile PL, Onwuteaka-Philipsen BD et al (2013) Palliative care service use in four European countries: a cross-national retrospective study via representative networks of general practitioners. PLoS ONE 8(12):e84440PubMedPubMedCentralCrossRef

93.

Yamaguchi T, Kuriya M, Morita T, Agar M, Choi YS, Goh C, Lingegowda KB, Lim R, Liu RK, MacLeod R et al (2017) Palliative care development in the Asia–Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN). BMJ Support Palliat Care 7(1):23–31PubMedCrossRef

94.

Clark D, Wright M, Hunt J, Lynch T (2007) Hospice and palliative care development in Africa: a multi-method review of services and experiences. J Pain Symptom Manag 33(6):698–710CrossRef

Title: Palliative care interventions in intensive care unit patients
Authors: Victoria Metaxa
Despina Anagnostou
Savvas Vlachos
Nishkantha Arulkumaran
Sherihane Bensemmane
Ingeborg van Dusseldorp
Rebecca A. Aslakson
Judy E. Davidson
Rik T. Gerritsen
Christiane Hartog
J. Randall Curtis
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: Intensive Care Medicine / Issue 12/2021
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06544-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Palliative care interventions in intensive care unit patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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