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 | [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] [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 | [50] |
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) | [59] |
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] |