K Adler1, D Schlieper1, D Kindgen-Milles2, S Meier2, J Schwartz3, P van Caster1, M S Schaefer2, M Neukirchen1. 1. Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland. 2. Klinik für Anästhesiologie, Universitätsklinikum Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland. 3. Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland. jacqueline.schwartz@med.uni-duesseldorf.de.
Abstract
BACKGROUND: One of the prime aims of intensive care is to cure patients or at least to extend life duration, sometimes to the extent of losing quality of life. Palliative care aims to improve the quality of life of patients with life-limiting conditions; however, some patients need both intensive and palliative care. About 5-10% of all deaths in Germany and 20% of all deaths in the USA occur in an intensive care unit (ICU) and many of those as well as other patients may benefit from palliative care consultation. Palliative care consultations are increasingly available for intensive care patients but are still infrequently used. OBJECTIVES: We aimed to determine the current situation of palliative patients in ICU settings: what is the impact of palliative care interventions on the quality of care of ICU patients? To what extent is palliative care support at ICUs available and to what extent is it used? Which factors trigger palliative care consultations? METHOD: We set out with a search of PubMed, Scopus and other databases in English and on a) the impact of palliative care interventions on the quality of care of ICU patients, b) the utilization of palliative care support in ICUs and c) the factors which trigger palliative care consultations. We included both quantitative and qualitative studies to reflect the views of all parties involved. To emphasize the situation in German-speaking countries we also searched Google Scholar with search terms in German and added those results to the review. Additionally, hand-searched studies in English and in German were included. RESULTS: We screened 695 abstracts and identified 18 relevant articles of which 15 were from the USA and Great Britain, 1 each was from Austria, Germany and Switzerland. Palliative care is a meaningful addition to ICU standard treatment: it can improve quality of care and helps reduce length of stay in an ICU. It is unclear if the reduced length of stay leads to economic benefits; however, the utilization of palliative care is inconsistent and infrequent as is its acceptance among ICU physicians. Trigger factors can be used to improve the integration of palliative care support in ICUs and point out patients' unmet palliative needs. DISCUSSION: Trigger factors can reduce barriers which hold back the integration of palliative care in ICUs. Early integration of palliative care can improve quality of care by offering psychological support to patients and their families and by providing collegial consultation. An ongoing prospective study is investigating the acceptance of trigger factors in the daily routine among ICU physicians in Germany.
BACKGROUND: One of the prime aims of intensive care is to cure patients or at least to extend life duration, sometimes to the extent of losing quality of life. Palliative care aims to improve the quality of life of patients with life-limiting conditions; however, some patients need both intensive and palliative care. About 5-10% of all deaths in Germany and 20% of all deaths in the USA occur in an intensive care unit (ICU) and many of those as well as other patients may benefit from palliative care consultation. Palliative care consultations are increasingly available for intensive care patients but are still infrequently used. OBJECTIVES: We aimed to determine the current situation of palliative patients in ICU settings: what is the impact of palliative care interventions on the quality of care of ICU patients? To what extent is palliative care support at ICUs available and to what extent is it used? Which factors trigger palliative care consultations? METHOD: We set out with a search of PubMed, Scopus and other databases in English and on a) the impact of palliative care interventions on the quality of care of ICU patients, b) the utilization of palliative care support in ICUs and c) the factors which trigger palliative care consultations. We included both quantitative and qualitative studies to reflect the views of all parties involved. To emphasize the situation in German-speaking countries we also searched Google Scholar with search terms in German and added those results to the review. Additionally, hand-searched studies in English and in German were included. RESULTS: We screened 695 abstracts and identified 18 relevant articles of which 15 were from the USA and Great Britain, 1 each was from Austria, Germany and Switzerland. Palliative care is a meaningful addition to ICU standard treatment: it can improve quality of care and helps reduce length of stay in an ICU. It is unclear if the reduced length of stay leads to economic benefits; however, the utilization of palliative care is inconsistent and infrequent as is its acceptance among ICU physicians. Trigger factors can be used to improve the integration of palliative care support in ICUs and point out patients' unmet palliative needs. DISCUSSION: Trigger factors can reduce barriers which hold back the integration of palliative care in ICUs. Early integration of palliative care can improve quality of care by offering psychological support to patients and their families and by providing collegial consultation. An ongoing prospective study is investigating the acceptance of trigger factors in the daily routine among ICU physicians in Germany.
Authors: Mark Finkelstein; Nathan E Goldstein; Jay R Horton; David Eshak; Eric J Lee; Roopa Kohli-Seth Journal: J Crit Care Date: 2016-04-23 Impact factor: 3.425
Authors: Ellen B Clarke; J Randall Curtis; John M Luce; Mitchell Levy; Marion Danis; Judith Nelson; Mildred Z Solomon Journal: Crit Care Med Date: 2003-09 Impact factor: 7.598
Authors: Glenn Gade; Ingrid Venohr; Douglas Conner; Kathleen McGrady; Jeffrey Beane; Robert H Richardson; Marilyn P Williams; Marcia Liberson; Mark Blum; Richard Della Penna Journal: J Palliat Med Date: 2008-03 Impact factor: 2.947
Authors: Nicholas Braus; Toby C Campbell; Kristine L Kwekkeboom; Susan Ferguson; Carrie Harvey; Anna E Krupp; Tara Lohmeier; Michael D Repplinger; Ryan P Westergaard; Elizabeth A Jacobs; Kate Ford Roberts; William J Ehlenbach Journal: Intensive Care Med Date: 2015-11-10 Impact factor: 17.440
Authors: Kathrin Adler; Daniel Schlieper; Detlef Kindgen-Milles; Stefan Meier; Manuela Schallenburger; Timur Sellmann; Heidrun Schwager; Jacqueline Schwartz; Martin Neukirchen Journal: Intensive Care Med Date: 2018-11-20 Impact factor: 17.440
Authors: Tanja Fehm; Frederik A Stübs; Martin C Koch; Peter Mallmann; Christian Dannecker; Anna Dietl; Anna Sevnina; Franziska Mergel; Laura Lotz; Anne Ehret; Daniel Gantert; Franca Martignoni; Jan-Philipp Cieslik; Jan Menke; Olaf Ortmann; Carmen Stromberger; Karin Oechsle; Beate Hornemann; Friederike Mumm; Christoph Grimm; Alina Sturdza; Edward Wight; Kristina Loessl; Michael Golatta; Volker Hagen; Timm Dauelsberg; Ingo Diel; Karsten Münstedt; Eberhard Merz; Dirk Vordermark; Katja Lindel; Christian Wittekind; Volkmar Küppers; Ralph Lellé; Klaus Neis; Henrik Griesser; Birgit Pöschel; Manfred Steiner; Ulrich Freitag; Tobias Gilster; Alexander Schmittel; Michael Friedrich; Heidemarie Haase; Marion Gebhardt; Ludwig Kiesel; Michael Reinhardt; Michael Kreißl; Marianne Kloke; Lars-Christian Horn; Regina Wiedemann; Simone Marnitz; Anne Letsch; Isabella Zraik; Bernhard Mangold; Jochen Möckel; Céline Alt; Pauline Wimberger; Peter Hillemanns; Kerstin Paradies; Alexander Mustea; Dominik Denschlag; Ulla Henscher; Reina Tholen; Simone Wesselmann; Matthias W Beckmann Journal: Geburtshilfe Frauenheilkd Date: 2022-02-11 Impact factor: 2.915
Authors: May Hua; Laura D Fonseca; R Sean Morrison; Hannah Wunsch; Robert Fullilove; Douglas B White Journal: J Pain Symptom Manage Date: 2021-06-25 Impact factor: 3.612
Authors: J Berendt; C Ostgathe; S T Simon; M Tewes; D Schlieper; M Schallenburger; S Meier; S Gahr; J Schwartz; M Neukirchen Journal: Med Klin Intensivmed Notfmed Date: 2020-08-07 Impact factor: 0.840