Palliative care teams in the intensive care unit: a randomised, controlled, feasibility study

Area of Science:

• Critical Care Medicine
• Palliative Care
• Health Services Research

Background:

• End-of-life care in intensive care units (ICUs) presents complex challenges for patients, families, and healthcare staff.
• Palliative care teams aim to improve quality of life and symptom management for patients with serious illnesses.
• The integration of palliative care into the ICU setting is an area of ongoing investigation.

Purpose of the Study:

• To assess the feasibility and potential impact of palliative care team consultations on patient, family, and staff satisfaction.
• To evaluate the effect of palliative care consultations on surrogate markers of healthcare costs, such as length of stay.
• To explore the utility of palliative care involvement in intensive care unit end-of-life care.

Main Methods:

• A randomized controlled feasibility study was conducted in a 14-bed general ICU over 29 months.
• Patients with terminal or preterminal conditions were enrolled, receiving either standard ICU care or standard care plus palliative care consultation.
• Outcomes included ICU and hospital length of stay, and changes in composite satisfaction scores from families, nursing staff, and intensivists.

Main Results:

• The study experienced significant logistical and methodological challenges, including low patient recruitment and questionnaire completion rates.
• A total of 20 patients were enrolled, with 10 in each group; baseline characteristics differed significantly.
• No statistically significant differences were observed between the groups in ICU length of stay, hospital length of stay, or changes in overall satisfaction scores.

Conclusions:

• This feasibility study encountered substantial difficulties and did not provide robust conclusions regarding the benefits of palliative care teams in the ICU.
• The study suggests that larger trials may be technically possible but are unlikely to be feasible given the observed challenges.
• Further investigation into effective models for integrating palliative care in critical care settings is warranted.