Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Neurocritical Care
Published in: Neurocritical Care 2/2016

01-10-2016 | Original Article

Palliative Care Consultations in the Neuro-ICU: A Qualitative Study

Authors: Len N. Tran, Anthony L. Back, Claire J. Creutzfeldt

Published in: Neurocritical Care | Issue 2/2016

Login to get access

Abstract

Background

Integration of palliative care (PC) into the neurological intensive care unit (neuro-ICU) is increasingly recommended, but evidence regarding the best practice is lacking. We conducted a qualitative analysis exploring current practices and key themes of specialist PC consultations in patients admitted to a single neuro-ICU.

Methods

We retrospectively identified all patients who were admitted to the neuro-ICU for ≥24 h and received a PC consultation between January and August 2014. We reviewed PC consultation notes and neuro-ICU progress notes from the electronic health records of these patients. We performed content analysis on the PC notes.

Results

Twenty-five neuro-ICU patients (4 %) received a PC consultation over 8 months with the most prevalent reason of clarifying goals of care. The main distinctions between patients with and those without (n = 580) a PC consultation were ICU length of stay (median 8.2 vs. 2.8 days) and death in the neuro-ICU (56 % vs. 11 %). The most prevalent themes addressed in the PC consultation notes were (1) discussing prognosis, (2) eliciting patient and family values, (3) understanding medical options, and (4) identifying conflict.

Conclusions

PC consultations in the neuro-ICU emphasize family coping and decision-making by helping discuss prognosis and exploring patient and family values as well as their ability to understand the medical information. Several features suggest that earlier integration of PC into neuro-ICU care may enhance both coping and the decision-making process.
Literature
1.
May P, Garrido MM, Cassel JB, et al. Prospective cohort study of hospital palliative care teams for inpatients with advanced cancer: earlier consultation Is associated with larger cost-saving effect. J Clin Oncol. 2015;33(25):2745–52.CrossRefPubMedPubMedCentral
2.
Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med. 2015;43(5):1102–11.CrossRefPubMedPubMedCentral
3.
Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.CrossRefPubMed
4.
Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741–9.CrossRefPubMedPubMedCentral
5.
Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30.CrossRefPubMed
6.
Yoong J, Park ER, Greer JA, et al. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013;173(4):283–90.CrossRefPubMed
7.
Creutzfeldt CJ, Longstreth WT, Holloway RG. Predicting decline and survival in severe acute brain injury: the fourth trajectory. BMJ. 2015;351:h3904.CrossRefPubMed
8.
Frontera JA, Curtis JR, Nelson JE, et al. Integrating palliative care into the care of neurocritically ill patients: a report from the improving palliative care in the ICU project advisory board and the center to advance palliative care. Crit Care Med. 2015;43(9):1964–77.CrossRefPubMedPubMedCentral
9.
Souter MJ, Blissitt PA, Blosser S, et al. Recommendations for the critical care management of devastating brain injury: prognostication, psychosocial, and ethical management: a position statement for healthcare professionals from the neurocritical care society. Neurocrit Care. 2015;23(1):4–13.CrossRefPubMed
10.
Noble H, Smith J. Issues of validity and reliability in qualitative research. Evid Based Nurs. 2015;18(2):34–5.CrossRefPubMed
11.
12.
13.
Jacobsen J, Jackson V, Dahlin C, et al. Components of early outpatient palliative care consultation in patients with metastatic nonsmall cell lung cancer. J Palliat Med. 2011;14(4):459–64.CrossRefPubMed
14.
Ubel PA, Loewenstein G, Schwarz N, Smith D. Misimagining the unimaginable: the disability paradox and health care decision making. Health Psychol. 2005;24(4 Suppl):S57–62.CrossRefPubMed
15.
Creutzfeldt CJ, Holloway RG. Treatment decisions after severe stroke: uncertainty and biases. Stroke. 2012;43(12):3405–8.CrossRefPubMed
16.
Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of critical care medicine. Crit Care Med. 2008;36(3):953–63.CrossRefPubMed
17.
Nelson JE, Curtis JR, Mulkerin C, et al. Choosing and using screening criteria for palliative care consultation in the ICU: a report from the improving palliative care in the ICU (IPAL-ICU) advisory board. Crit Care Med. 2013;41(10):2318–27.CrossRefPubMed
18.
Curtis JR, Rubenfeld GD, editors. Managing death in the intensive care unit: the transition from cure to comfort. 1st ed. New York: Oxofrd University; 2000.
19.
Campbell TC, Carey EC, Jackson VA, et al. Discussing prognosis: balancing hope and realism. Cancer J. 2010;16(5):461–6.CrossRefPubMed
20.
Quill TE, Abernethy AP. Generalist plus specialist palliative care–creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.CrossRefPubMed
21.
Institute of Medicine CoQoHCiA. Dying in America: improving quality and honoring individual preferences near the end of life. 1st ed. Washington DC: National Academies Press; 2015.
Metadata
Title
Palliative Care Consultations in the Neuro-ICU: A Qualitative Study
Authors
Len N. Tran
Anthony L. Back
Claire J. Creutzfeldt
Publication date
01-10-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0283-5

Other articles of this Issue 2/2016

Neurocritical Care 2/2016 Go to the issue

Original Article

Risk Factors for Infections Related to Lumbar Drainage in Spontaneous Subarachnoid Hemorrhage

Original Article

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage

Original Article

Controlled Hypercapnia Enhances Cerebral Blood Flow and Brain Tissue Oxygenation After Aneurysmal Subarachnoid Hemorrhage: Results of a Phase 1 Study

Original Article

Early Withdrawal Decision-Making in Patients with Coma After Cardiac Arrest: A Qualitative Study of Intensive Care Clinicians

Original Article

Safety of Chemical DVT Prophylaxis in Severe Traumatic Brain Injury with Invasive Monitoring Devices

Translational research

Long-Term Cognitive Deficits After Subarachnoid Hemorrhage in Rats