Consensus statements on end-of-life care in ICU - A Scandinavian multidisciplinary Delphi study

Area of Science:

• Critical Care Medicine
• Palliative Care
• Medical Ethics

Background:

• End-of-life care in Intensive Care Units (ICUs) presents complex ethical, cultural, and medical challenges.
• Ensuring patient comfort and dignity during end-of-life care is paramount for critically ill patients and their families.

Purpose of the Study:

• To develop core domains and consensus statements for end-of-life care in Scandinavian ICUs.
• To incorporate perspectives from patients, families, and multidisciplinary experts.

Main Methods:

• A three-round Delphi study involving a multidisciplinary advisory board from five Scandinavian countries.
• Inclusion of ICU physicians, nurses, palliative care specialists, and former ICU patients/families.
• Ranking of potential domains and iterative refinement of consensus statements based on expert and clinician feedback.

Main Results:

• Consensus was reached on 59 statements across 10 core domains after the third Delphi round.
• The 10 domains cover communication, therapy decisions, spiritual needs, mechanical ventilation, symptom management, sedation, palliative care consultations, patient transfers, bereavement care, and post-death debriefing.
• These domains address critical aspects of end-of-life care in the ICU setting.

Conclusions:

• Developed core domains and consensus statements aim to optimize end-of-life care in Scandinavian ICUs.
• The established domains consider cultural and ethical nuances specific to the region.
• These findings can inform the development of improved end-of-life care guidelines for ICUs.