Most people could be forgiven for thinking that palliative care and the ICU do not go together, but the reality is starkly different.
The importance and potential benefits of palliative care to ease suffering and improve quality of life for patients being treated in hospital intensive care units (ICUs) has received increasing recognition but is not without significant challenges, as discussed in a Roundtable discussion in Journal of Palliative Medicine
, a peer-reviewed journal published by Mary Ann Liebert, Inc. (http://www.liebertpub.com
). Journal of Palliative Medicine
is the Official Journal of the Center to Advance Palliative Care (CAPC) and an Official Journal of the Hospice and Palliative Nurses Association (HPNA). The Roundtable is available free online at http://www.liebertpub.com/jpm
Palliative care in the ICU requires a team effort. A multidisciplinary group of health care experts share their experiences, views, and advice as participants in a roundtable discussion, "Palliative Care in the ICU (http://online.liebertpub.com/doi/full/10.1089/jpm.2011.9599
)," led by moderator Judith Nelson, MD, JD, Professor of Medicine and Project Director, The IPAL-ICU Project, Mount Sinai School of Medicine, New York, NY. The participants included: Elie Azoulay, MD, H˘pital Saint-Louis, UniversitÚ Paris VII, France; J. Randall Curtis, MD, MPH, Harborview Medical Center, University of Washington, Seattle; Anne Mosenthal, MD, UMDNJ-NJMS, Newark, NJ; Colleen Mulkerin, MSW, LCSW, Hartford Hospital, CT; Kathleen Puntillo, RN, DNSc, University of California, San Francisco; and Mark Siegel, MD, Yale School of Medicine, Yale-New Haven Hospital, CT.
Patients in the ICU are often at high risk of dying and may be on life support or require intensive monitoring. There has been a significant shift in the critical care community toward increasing recognition of the needs of ICU patients and families and the potential for greater use of palliative care to ease their suffering and provide psychological support.
The IPAL-ICU Project of the Center to Advance Palliative Care is supported by the National Institutes of Health and is working to develop recommendations to guide the implementation of palliative care principles and practices in the ICU, focusing on the special issues affecting patients, families, and caregivers in the ICU environment.
"It seems clear that palliative care in the ICU improves the quality of care for both patients and their families. I suspect this will become standard of care in all hospitals in coming years," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine
, and Provost, Institute for Palliative Medicine at San Diego Hospice.