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Table 1 Recommended system of the primary palliative care in the intensive care unit

From: Primary palliative care recommendations for critical care clinicians

Target Interventions References
Patient Basic symptom relief for fatigue, thirst, and pain
Prevention for the post-ICU syndrome
The timing of initiation of the palliative care should be tailored based on the trajectory of the illness
[1, 9,10,11,12]
[13,14,15,16,17,18,19,20]
[21]
Family Patient-/family-centered decision-making
Emotional and practical support
Structured family communication and brochures for families
The introduction of a communication facilitator or family support coordinator to support the primary team and facilitate structured communication
[23]
[23]
[24,25,26,27]
[25]
Clinician Education about palliative care (didactic and simulation trainings)
Bedside tools and techniques
Real-time collaboration and feedback with subspecialty-trained palliative clinicians
Communication skills training for the goals-of-care discussion
Implement multifaceted bundles to improve critical care clinicians’ ability to provide palliative care
Palliative care interventions on critical care clinician wellness
“Death rounds” in the ICU
[39, 40]
[39, 40]
[39, 40]
[41,42,43,44,45,46,47]
[48, 49]
[50]
[51, 52]
System-level Triggered palliative consultations
Simulations for intensivists to record their estimate of a patient’s 3-month functional outcome
The implementation of an order set focused on the care processes surrounding withdrawal of life-sustaining treatment (including preparations, sedation/analgesia, withdrawal of ventilation and principals of life support)
[57, 58]
[59]
[60, 61]
Multilevel Family-facing: scheduled, end-of-life conferences and bereavement brochure + Clinician-facing: communication skills training for goals-of-care conversations
System-level: triggered palliative care consultations + Clinician-facing: palliative care assessment form in the medical records + Family-facing: family-involvement in decision-making with the use of time-limited trial
System-level: hospital policy for a three-tiered classification for the intensity of care/resuscitation, comprehensive care team evaluation + Family-facing: family-involvement in decision-making
Clinician-facing: a 12-h communication skills training for ICU nurse champion + Family-facing: daily, structured family support meetings + System-level: implementation specialist for each ICU to incorporate the above into regular workflow
[30]
[62]
[63]
[64]