Physicians just need to be better trained to provide the best care at the end-of-life

Excerpt

Over the last decades, caring for terminally ill patients, either in the latter phases of progressive chronic diseases or in the setting of refractory organ failures in the course of acute critical illnesses, has become very frequent in intensive care units (ICUs) and such demand is expected to increase substantially in the next decades [1]. Although the end-of-life (EOL) decision-making process and the consequent strategy vary largely depending on several factors such as cultural aspects, religious beliefs, legal burdens, ethical and moral values, medical knowledge regarding terminally ill diseases and palliative care, up to three-quarters of all ICU deaths are preceded by limitations of treatment [2, 3]. However, the care provided to patients at the EOL and their families needs to be urgently improved. Current information indicates that EOL care in ICUs is frequently inappropriate as a consequence of several factors including poor communication [4], inadequate symptom control [5] and divergence among the ICU team, families and the patients themselves regarding their expectations and values [6]. It is well known that conflicts in the context of EOL are perceived as much more severe and dangerous when compared to other conflicts [6]. …