Improving End-of-Life Care in the ICU

A survey of intensive care unit (ICU) nurses and doctors has revealed the main barriers to better care for end-of-life ICU patients and suggests strategies for improvements. The survey results were presented at the international conference of the American Thoracic Society in Seattle (WA, USA).

Important barriers to better care included unrealistic expectations on the part of patients or families about the prognosis of patients or the effectiveness of ICU treatment, the inability of patients to participate in treatment discussions, the lack of advance directives from patients about their end-of-life treatment, insufficient training of doctors in communicating about end-of-life issues, competing demands for doctors' time, and disagreements within families about the appropriate goals of patient care.

Among the strategies suggested by ICU directors for improving care were 14 rated by 80% of respondents as being helpful. These included training doctors in communications skills, training doctors in symptom management, quality monitoring of end-of-life care, access to experts in palliative care, regular visits to the ICU by pastoral care representatives, regularly scheduled meetings of a senior ICU doctor and nurse with families of patients, and bereavement programs for families.

In response to the survey questionnaire, sent to 1,200 ICU directors at 600 US ICUs, about 78% of ICUs (468) responded and 50% of ICU directors (590) responded. A number of the suggested strategies for improvement are not now available in many ICUs. For example, less than 30% of respondents reported the availability of end-of-life care quality monitoring or bereavement programs. Only 35% had regularly scheduled meetings with senior ICU clinicians and families, and only 40% reported the availability of training in communications skills for clinicians.

"ICUs are designed to save lives and rescue very sick patients, but the reality is that many patients die in ICUs,” said lead researcher Judith Nelson, M.D., J.D., associate professor of medicine at the Mount Sinai School of Medicine (New York, NY, USA). "Patients, family members, healthcare workers, and others have identified a need to improve various aspects of care at the end of life for critically ill patients.”




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