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Palliative care interventions in intensive care unit patients

  • Systematic Review
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A Correction to this article was published on 21 December 2021

This article has been updated

Abstract

Purpose

The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear.

Methods

We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries.

Results

Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies.

Conclusion

Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.

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Funding

Supported by the ESICM Systematic Review Group (SRG).

Author information

Authors and Affiliations

  1. King’s College Hospital, London, SE5 9RS, UK

    Victoria Metaxa & Savvas Vlachos

  2. School of Medicine, Human Health Sciences, Kyoto University, Kyoto, Japan

    Despina Anagnostou

  3. Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK

    Nishkantha Arulkumaran

  4. Health Services Research, Epidemiology and Public Health, Sciensano, Brussels, Belgium

    Sherihane Bensemmane

  5. van Dusseldorp, Delvaux en Ket, Groningen, The Netherlands

    Ingeborg van Dusseldorp

  6. Division of Primary Care and Population Health, Department of Medicine, Palliative Care Section, Stanford University, Stanford, CA, 94305, USA

    Rebecca A. Aslakson

  7. Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, 94305, USA

    Rebecca A. Aslakson

  8. Department of Nursing, University of California, San Diego Health Sciences, San Diego, USA

    Judy E. Davidson

  9. Centrum voor Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands

    Rik T. Gerritsen

  10. Klinik Bavaria Kreischa, Kreischa, Germany

    Christiane Hartog

  11. Division of Pulmonary, Critical Care and Sleep Medicine, Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA

    J. Randall Curtis

Authors
  1. Victoria Metaxa
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  2. Despina Anagnostou
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  3. Savvas Vlachos
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  4. Nishkantha Arulkumaran
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  5. Sherihane Bensemmane
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  6. Ingeborg van Dusseldorp
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  7. Rebecca A. Aslakson
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  8. Judy E. Davidson
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  9. Rik T. Gerritsen
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  10. Christiane Hartog
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  11. J. Randall Curtis
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Corresponding author

Correspondence to Victoria Metaxa.

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Conflicts of interest

VM, AD, SV, NA, SB, IvD, JED, RTG: no CoI. RA: Patient-Centred Outcomes Research Institute. CH: German Innovations Fund of the Federal Joint Committee in Germany, European Society of Intensive Care Medicine. JRC: National Institutes of Health and the Cambia Health Foundation.

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Metaxa, V., Anagnostou, D., Vlachos, S. et al. Palliative care interventions in intensive care unit patients. Intensive Care Med 47, 1415–1425 (2021). https://doi.org/10.1007/s00134-021-06544-6

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