Palliative care in the ICU
The importance and potential benefits of palliative care to ease suffering and improve quality of life for patients being treated in hospital intensive care units (ICUs) has received increasing recognition but is not without significant challenges, as discussed in a roundtable discussion in a recent issue of the Journal of Palliative Medicine.
Palliative care in the ICU requires a team effort. A multidisciplinary group of healthcare experts shared their experiences, views, and advice as participants in the roundtable discussion, Palliative care in the ICU, held in summer 2011 and appearing in a recent issue of Journal of Palliative Medicine. (For information about accessing the discussion, see resource, below.) The discussion was led by moderator Judith Nelson, MD, JD, professor of medicine and project director, Improving Palliative Care in the ICU (IPAL-ICU) Project, Mount Sinai School of Medicine, New York City. The participants included: Elie Azoulay, MD, Hôpital Saint-Louis, Université Paris VII, France; J. Randall Curtis, MD, MPH, Harborview Medical Center, University of Washington, Seattle; Anne Mosenthal, MD, University of Medicine and Dentistry of New Jersey — New Jersey Medical School (UMDNJ-NJMS), Newark, NJ; Colleen Mulkerin, MSW, LCSW, Hartford Hospital, CT; Kathleen Puntillo, RN, DNSc, University of California, San Francisco; and Mark Siegel, MD, Yale School of Medicine, Yale — New Haven Hospital, CT.
Patients in the ICU are often at high risk of dying and might be on life support or require intensive monitoring. There has been a significant shift in the critical care community toward increasing recognition of the needs of ICU patients and families and the potential for greater use of palliative care to ease their suffering and provide psychological support.
The IPAL-ICU Project of the Center to Advance Palliative Care is supported by the National Institutes of Health and is working to develop recommendations to guide the implementation of palliative care principles and practices in the ICU, focusing on the special issues affecting patients, families, and caregivers in the ICU environment.
"It seems clear that palliative care in the ICU improves the quality of care for both patients and their families. I suspect this will become standard of care in all hospitals in coming years," says Charles F. von Gunten, MD, PhD, editor-in-chief of Journal of Palliative Medicine, and provost, Institute for Palliative Medicine at San Diego Hospice.
Resource
- The roundtable is available for free online at http://online.liebertpub.com/doi/full/10.1089/jpm.2011.9599.
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