Photo Credit: Jacob Wackerhausen
Palliative care focuses on communication, advanced directives, and control of symptoms, with the goal of better ICU outcomes through patient and family support.
As a critical care physician, my primary emphases include diagnosis, treatment, and, hopefully, recovery of the acutely ill or traumatized patient. Palliative care helps these patients and families by emphasizing communication, application of advanced directives, and control of symptoms. This may lead to greater patient and family respect and, we hope, better ICU outcomes.
Advanced care planning is an increasingly important part of palliative intensive care. It involves communicating with families and, when possible, patients to ensure that the care delivered is aligned with their principles, beliefs, and wishes. Open communication and psychologic and spiritual support aid both families and afflicted patients in dealing with critical illness.
A significant confounder of the idea and practice of palliative intensive care is the perception, by both healthcare professionals and the public, of palliative care as analogous to hospice care or end-of-life care. Palliation is vital in hospice care and other interventions at the end of life, but the same principles may be applied to any seriously ill or traumatized patient. Acutely ill or injured patients may, at times, need to receive primarily active treatments in search of curative interventions, while other patients may depend more on symptom alleviation. In either case, it is best to consider the ICU patient needing a combination of both approaches.
Palliative intensive care may be provided in several ways, including a consultative model, either team-sponsored, mandatory, or protocol-driven, or an embedded model in which the palliative providers are a formal part of the rounding ICU team. My preferences involve an embedded model with early but not mandated palliative consultation. Larger and increasing populations of ICU patients (such as in the COVID-19 pandemic) are particularly appropriate for the embedded model as more patients may benefit from effective and expeditious palliative care without a commensurate increase in resources or costs. The precise models used, however, are most significantly determined by each hospital’s or unit’s panel size and palliative staff availability. Whichever model is chosen, integrating palliative care in the ICU will ensure that our patients’ management is compassionate and focused on the patient and family.
