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Integrating palliative care in the ICU

Hua, Maya; Wunsch, Hannaha,b,c

Current Opinion in Critical Care: December 2014 - Volume 20 - Issue 6 - p 673–680
doi: 10.1097/MCC.0000000000000149
ETHICAL, LEGAL AND ORGANIZATIONAL ISSUES IN THE ICU: Edited by Hannah Wunsch
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Purpose of review Although providing palliative care in the ICU has become a priority, the success of different methods to integrate palliative care into the ICU has varied. This review examines the current evidence supporting the different models of palliative care delivery and highlights areas for future study.

Recent findings The need for palliative care for ICU patients is substantial. A large percentage of patients meet criteria for palliative care consultation and there is frequent use of intensive care and other nonbeneficial care at the end of life. Overall, the consultative model of palliative care appears to have more of an impact on patient care. However, given the current workforce shortage of palliative care providers, a sustainable model of delivering palliative care requires both an effective integrative model, in which palliative care is delivered by ICU clinicians, and appropriate use of the consultative model, in which palliative care consultation is reserved for patients at highest risk of having unmet or long-term palliative care needs.

Summary Developing a mixed model of palliative care delivery is necessary to meet the palliative care needs of critically ill patients. Efforts focused on improving integrative models and appropriately targeting the use of palliative care consultants are needed.

aDepartment of Anesthesiology, Columbia University, New York, New York, USA

bDepartment of Critical Care Medicine, Sunnybrook Hospital

cDepartment of Anesthesia, University of Toronto, Toronto, Ontario, Canada

Correspondence to May Hua, MD, Department of Anesthesiology, Columbia University, 622 West 168th Street PH5, Room 535 New York, NY 10032, USA. Tel: +1 212 305 1982; fax: +1 212 305 3204; e-mail: mh2633@cumc.columbia.edu

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