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Hospice and Palliative Care for Patients in the Intensive Care Unit: Current Status in Countries Other than Korea

  • Minkyu, Jung (Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine)
  • Received : 2023.01.27
  • Accepted : 2023.02.27
  • Published : 2023.03.01

Abstract

Although most patients prefer dying at home, patients whose condition rapidly becomes critical need care in the intensive care unit (ICU), and it is rare for them to die at home with their families. Therefore, interest in hospice and palliative care for patients in the ICU is increasing. Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU: patients with chronic critical illnesses who need tracheostomy, percutaneous gastrostomy tube, and extracorporeal life support; patients aged 80 years or older; stage 4 cancer patients; patients with specific acute diseases with a poor prognosis (e.g., anoxic brain injury and intracerebral hemorrhage requiring mechanical ventilation); and patients for whom the attending physician expects a poor prognosis. There are two PC models-a consultative model and an integrative model-in the ICU setting. Since these two models have advantages and disadvantages, it is necessary to apply the model that best fits each hospital's circumstances. Furthermore, interdisciplinary decision-making between the ICU care team and PC specialists should be strengthened to increase the provision of hospice and palliative care services for patients expected to have poor outcomes and their families.

Keywords

References

  1. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al., Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 2004;32:638-43.  https://doi.org/10.1097/01.CCM.0000114816.62331.08
  2. Teno JM, Gozalo PL, Bynum JP, Leland NE, Miller SC, Morden NE, et al., Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA 2013;309:470-7.  https://doi.org/10.1001/jama.2012.207624
  3. Mularski RA, Heine CE, Osborne ML, Ganzini L, Curtis JR. Quality of dying in the ICU: ratings by family members. Chest 2005;128:280-7.  https://doi.org/10.1016/s0012-3692(15)37958-7
  4. Campbell ML, Guzman JA. A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Crit Care Med 2004;32:1839-43.  https://doi.org/10.1097/01.CCM.0000138560.56577.88
  5. Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, et al. Models for structuring a clinical initiative to enhance PC in the intensive care unit: a report from the IPAL-ICU Project (Improving PC in the ICU). Crit Care Med 2010;38:1765-72.  https://doi.org/10.1097/CCM.0b013e3181e8ad23
  6. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007;356:469-78.  https://doi.org/10.1056/NEJMoa063446
  7. Carson SS, Cox CE, Wallenstein S, Hanson LC, Danis M, Tulsky JA, et al. Effect of PC-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 2016;316:51-62.  https://doi.org/10.1001/jama.2016.8474