Preferences and Predictions Regarding Palliative Care in the Trauma Intensive Care Unit

Area of Science:

• Geriatric Trauma Care
• Intensive Care Medicine
• Palliative Care Research

Background:

• End-of-life decision-making is frequent in older intensive care unit (ICU) trauma patients.
• Significant uncertainty exists among patients and providers regarding these critical decisions.

Purpose of the Study:

• To assess patient and provider uncertainty in end-of-life (EOL) care decisions for older trauma ICU patients.
• To identify factors contributing to this uncertainty, such as surrogate involvement and prior discussions.

Main Methods:

• Prospective observational study of trauma patients aged 50+ in the ICU.
• Surveys administered to patients or surrogates, and healthcare team members.
• Analysis of patient outcomes and team predictions over a 6-month follow-up period.

Main Results:

• Increased uncertainty observed when surrogates completed surveys or when no prior EOL discussions occurred.
• Healthcare team members (nurses, residents, attendings) showed similar survival predictions (82%), but overestimated 6-month survival (75%).
• Varied opinions on palliative care consults between nurses (27%) and physicians (18%) highlight communication gaps.

Conclusions:

• Prioritizing end-of-life (EOL) discussions and advance directives is essential for older trauma ICU patients.
• Enhanced interdisciplinary communication is necessary to align understanding and implementation of palliative care strategies.