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End-of-life care can be improved
November 02, 2006Researchers have evaluated improvements in the end-of-life care in intensive care units (ICU) and have shared their findings in a special supplement to Critical Care Medicine, the journal of the Society of Critical Care Medicine. The supplement is dedicated entirely to end-of-life care in the critical care setting.
"Improving the quality of care received by critically ill and dying patients in the ICU remains an ongoing challenge," explains guest co-editor J. Randall Curtis, M.D., M.P.H., professor of medicine at the University of Washington in Seattle. "Over the past five years there have been encouraging signs of improvement in end-of-life care in the ICU. Interventions have been developed, evaluated, and published to improve the care that patients and their families receive relating to the end of life in the ICU."
Approximately one in five deaths in the United States now occurs in the ICU or shortly after receiving intensive care. The ICU is likely to remain an important setting for end-of-life care because of the severity of illness in these patients and because many families and patients with chronic, life-limiting diseases will opt for a trial of intensive care.
Critical care researchers are taking the lessons learned from previous observational studies and using them to develop and test generalizable interventions that improve the quality of ICU end-of-life care. The Critical Care Medicine supplement includes 20 articles evaluating end-of-life issues, including palliative care in the ICU, attitudes toward withholding and withdrawing life support, ethical and legal issues, quality indicators, communications between physicians and nurses, interventions for children at the end of life, and promising future directions.
"We believe this supplement documents the tremendous progress that has been made in the past decade and represents the state of the art for assessing and improving end-of-life care in the ICU," comments guest co-editor Mitchell Levy, M.D., professor of medicine at Brown University School of Medicine in Providence, R.I.
Quality End-of-Life Palliative Care
A paper by Ira Byock, M.D., a professor at Dartmouth Medical School and director of palliative medicine at Dartmouth Hitchcock Medical Center in Lebanon, N.H., describes recent developments in the integration of palliative and critical care.
Palliative and end-of-life care in the ICU is an appropriate and under-developed area for quality assessment and improvement, according to Richard Mularski, M.D., M.S.H.S., from the Veterans Affairs Greater Los Angeles Healthcare System. Dr. Mularski and a number of the other contributors to this supplement combined forces to develop an article that provides a practical framework for examining processes of care that might be quality measures. This article proposes 18 candidate quality measures that could be implemented in ICUs tomorrow. Dr. Mularski and colleagues suggest that further work also is needed to demonstrate such measures are valid and reliable.
End-of-Life Interventions
Considering that 20% of deaths in the United States occur in ICUs and that the quality of life in an ICU at the end of life often is rated as poor, improving the quality of end-of-life care in this setting is seen as an important endeavor. In an article on measuring quality improvement, Dr. Curtis and co-author Ruth A. Engelberg, Ph.D., from the University of Washington in Seattle, examine data supporting potential process and outcome measures that could be used to evaluate the success of interventions designed to improve end-of-life care in the ICU.
Dr. Levy notes that this supplement documents a need for additional research and quality improvement in order to realize the potential for improving the care delivered to critically ill patients at the end of life as well as the care provided to their families.
The supplement resulted from the conference, "Improving the Quality of End-of-Life Care in the ICU: Interventions that Work," which was funded by the Robert Wood Johnson Foundation and hosted by the Society of Critical Care Medicine on February 17-19, 2006, in Miami, Fla.
Society of Critical Care Medicine
Critical care researchers are taking the lessons learned from previous observational studies and using them to develop and test generalizable interventions that improve the quality of ICU end-of-life care. The Critical Care Medicine supplement includes 20 articles evaluating end-of-life issues, including palliative care in the ICU, attitudes toward withholding and withdrawing life support, ethical and legal issues, quality indicators, communications between physicians and nurses, interventions for children at the end of life, and promising future directions.
"We believe this supplement documents the tremendous progress that has been made in the past decade and represents the state of the art for assessing and improving end-of-life care in the ICU," comments guest co-editor Mitchell Levy, M.D., professor of medicine at Brown University School of Medicine in Providence, R.I.
Quality End-of-Life Palliative Care
A paper by Ira Byock, M.D., a professor at Dartmouth Medical School and director of palliative medicine at Dartmouth Hitchcock Medical Center in Lebanon, N.H., describes recent developments in the integration of palliative and critical care.
Palliative and end-of-life care in the ICU is an appropriate and under-developed area for quality assessment and improvement, according to Richard Mularski, M.D., M.S.H.S., from the Veterans Affairs Greater Los Angeles Healthcare System. Dr. Mularski and a number of the other contributors to this supplement combined forces to develop an article that provides a practical framework for examining processes of care that might be quality measures. This article proposes 18 candidate quality measures that could be implemented in ICUs tomorrow. Dr. Mularski and colleagues suggest that further work also is needed to demonstrate such measures are valid and reliable.
End-of-Life Interventions
Considering that 20% of deaths in the United States occur in ICUs and that the quality of life in an ICU at the end of life often is rated as poor, improving the quality of end-of-life care in this setting is seen as an important endeavor. In an article on measuring quality improvement, Dr. Curtis and co-author Ruth A. Engelberg, Ph.D., from the University of Washington in Seattle, examine data supporting potential process and outcome measures that could be used to evaluate the success of interventions designed to improve end-of-life care in the ICU.
Dr. Levy notes that this supplement documents a need for additional research and quality improvement in order to realize the potential for improving the care delivered to critically ill patients at the end of life as well as the care provided to their families.
The supplement resulted from the conference, "Improving the Quality of End-of-Life Care in the ICU: Interventions that Work," which was funded by the Robert Wood Johnson Foundation and hosted by the Society of Critical Care Medicine on February 17-19, 2006, in Miami, Fla.
Society of Critical Care Medicine
End-of-life Care Current Events and End-of-life Care News RSSFamily members of critically ill patients want to discuss loved ones' uncertain prognoses
Critically ill patients frequently have uncertain prognoses, but their families overwhelmingly wish that physicians would address prognostic uncertainty candidly, according to a new study out of the University of San Francisco Medical Center.
Hopkins Children's study: Parents of dying newborns need clearer explanation of options
Parent-doctor discussions about whether to maintain or withdraw life support from terminally ill or severely premature newborns are so plagued by miscommunication and misunderstanding that they might as well be in different languages.
Survey compares views of trauma professionals, the public on dying from injuries
Most trauma professionals and members of the general public say they would prefer palliative care following a severe injury if physicians determined aggressive critical care would not save their lives, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
Depression and PTSD symptoms in caregivers of lung transplant patients
Symptoms of depression and post-traumatic stress disorder (PTSD) among caregivers of deceased lung transplant patients are four-to-five times more prevalent than in the average population, according to researchers who analyzed the stress levels of caregivers, as well as their perceptions of the transplant recipients' quality of dying and death.
Palliative care and legal euthanasia can be mutually beneficial
Supporters of legalising euthanasia and those who wish to develop better palliative care services can help each other, according to a study published today on bmj.com.
Scientists adopt fresh approach in quest for new therapies
Scientists are to pool their expertise in human health to pioneer an innovative approach to treating common diseases.
Place of death shifting for children with complex chronic conditions
It is becoming more common for children with complex chronic conditions to die in their home than in a hospital, although black and Hispanic children with these conditions are less likely to die in their home.
Early palliative care linked to shorter stays in intensive care
Researchers at the University of Rochester Medical Center have found that early palliative care interventions can reduce the length of stay for seriously ill patients in the medical intensive care unit (MICU) by more than seven days without having an impact on mortality rates.
Identifying medical proxy should be part of routine medical care
One-third of married individuals choose someone other than their spouse as a surrogate for medical decision-making. And more often than not, when adult patients chose a parent, sibling or child, they prefer their mothers, sisters and daughters to serve as medical proxies over their fathers, brothers and sons.
End-of-life treatment preferences may change as health declines
A study of older adults with advanced chronic illnesses indicates that as a patient's health declines, that individual may be more likely to accept treatments that would result in mild to severe functional disability.
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