Prospective study of a proactive palliative care rounding intervention in a medical ICU
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To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes.
Prospective, before-and-after interventional study enrolling patients with high risk of mortality, morbidity, or unmet palliative care needs in a 24-bed academic intensive care unit (ICU). The intervention involved a palliative care clinician interacting with the ICU physicians on daily rounds for high-risk patients.
One hundred patients were enrolled in the usual care phase, and 103 patients were enrolled during the intervention phase. The adjusted likelihood of a family meeting in ICU was 63 % higher (RR 1.63, 95 % CI 1.14–2.07, p = 0.01), and time to family meeting was 41 % shorter (95 % CI 52–28 % shorter, p < 0.001). Adjusted ICU length of stay (LOS) was not significantly different between the two groups (6 % shorter, 95 % CI 16 % shorter to 4 % longer, p = 0.22). Among those who died in the hospital, ICU LOS was 19 % shorter in the intervention (95 % CI 33–1% shorter, p = 0.043). Adjusted hospital LOS was 26 % shorter (95 % CI 31–20 % shorter, p < 0.001) with the intervention. Post-traumatic stress disorder (PTSD) symptoms were present in 9.1 % of family respondents during the intervention versus 20.7 % prior to the intervention (p = 0.09). Mortality, family depressive symptoms, family satisfaction and quality of death and dying did not significantly differ between groups.
Proactive palliative care involvement on ICU rounds for high-risk patients was associated with more and earlier ICU family meetings and shorter hospital LOS. We did not identify differences in family satisfaction, family psychological symptoms, or family-rated quality of dying, but had limited power to detect such differences.
KeywordsEnd-of-life care Palliative care ICU decision-making Family meetings Communication Family ICU syndrome
Dr. Ehlenbach has received grant funding from the National Institutes of Health, National Institute of Aging (K23 AG038352), funded by The Atlantic Philanthropies, The John A. Hartford Foundation, and the Starr Foundation. This work utilized the University of Wisconsin Carbone Cancer Center (UWCCC) Survey Resource Shared Resource, which is funded in part by the UWCCC Center Support Grant (P30 CA014520) from the National Cancer Institute; the authors wish to thank Amy Godecker, Ph.D., and Karen Lazar, M.S., for their work with the surveys for this study. Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at the University of Wisconsin-Madison, School of Medicine and Public Health. REDCap is supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Compliance with ethical standards
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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