Nav: Home

Palliative care offers no additional benefit to caretakers of chronically critically ill

July 12, 2016

CHAPEL HILL, N.C. - Shannon Carson, MD, professor of medicine and division chief of Pulmonary Diseases and Critical Care Medicine at the UNC School of Medicine, along with co-principal investigator Judith Nelson, MD, JD, at Memorial Sloan Kettering Cancer Center, and Christopher Cox, MD, of Duke University, led a four-year, first-of-its kind clinical study on the effects of palliative care for medical decision-makers.

The results, published July 5 in the Journal of the American Medical Association (JAMA), show that intensive care units in New York and North Carolina hospitals, where the study was conducted, provided communication and family support that was at least as sufficient as specialized interventions (palliative care) for families of chronically ill patients in the ICU. The researchers focused on investigating the psychological distress of caregivers and decision-makers for patients with a chronic critical illness, which is defined as dependence on a respirator for more than one week.

"We have long known that patients experiencing chronic critical illness have a very difficult time because of complications from their illness, long dependence on life support, and long hospitalizations," Carson said.

All of those things also make it difficult and stressful for family members, caretakers, and decision-makers - who are often the same people.

"It's very disruptive to their lives and their work, and - to complicate things even more - we rely on them to assist with a large amount of decision-making. It's very stressful for family members," Carson said. "As ICU physicians, we sometimes worry that we don't provide or aren't able to provide the support and information that families need to help with this decision-making in the most effective ways."

In trying to determine what could be done to keep families better informed and possibly lessen the associated stress and ease anxiety, Carson considered whether offering support from palliative care specialists would be beneficial. Participants in the randomized study were 365 family decision-makers for 250 ICU patients with chronic critical illness.

"We hoped that having families meet with palliative care physicians - at least a couple times -would help families cope better down the line," Carson said. "And so we randomized family members to either meet with palliative care physicians and nurses during the course of their family member's illness, or they received the usual care; all the information they received was from the ICU clinicians - physicians and nurses.

"What we found is that there was no benefit to having these additional meetings with palliative care clinicians. We found that the support and communication provided by the critical care team was quite good. We concluded that while it was an interesting and hopefully useful idea, for now it seems that the support provided by the regular ICU doctors is at least as sufficient as additional support provided by palliative care," Carson said.

In addition, no difference was found in the number of days a patient was in the hospital or the time the patient spent on a respirator or on other therapeutic interventions.

"As an intensivist, I find that to be a positive finding," he said. "We're doing at least as well as the gold standard in this setting. It provides reassurance. Even though we can always do better in communication, we're at least doing as well as anyone can. We will still need to consult palliative care for difficult situations, but routine consultation for all chronically critically ill patients will not be necessary."

University of North Carolina Health Care

Related Palliative Care Articles:

New palliative care model shown to reduce costs without compromising on quality of care
Findings from a large-scale clinical trial testing a new palliative care model have shown to be lower cost, viewed positively by patients and their carers while showing no difference in patient-reported outcomes when compared with standard care.
Palliative Care in emergency departments during COVID-19 pandemic
The clinical characteristics and outcomes of patients who received intervention by a COVID-19 palliative care response team are examined in this case series.
Palliative care for patients with cancer in COVID-19 era
The considerations and challenges affecting the palliative care specialty and delivery of palliative care in the COVID-19 era, as well as potential solutions, are discussed in this Viewpoint.
To face coronavirus disease 2019, surgeons must embrace palliative care
This Viewpoint describes the relevance of a palliative care approach to surgery during the coronavirus disease 2019 pandemic.
Call for palliative care to be adapted for severely ill Covid-19 patients
Emergency-style palliative care needs to implemented to meet the needs of Covid-19 patients who wouldn't benefit from a ventilator say researchers.
A COVID-19 palliative care pandemic plan: An essential tool
Palliative care physicians have created a coronavirus disease 2019 (COVID-19) palliative care plan as an essential tool to provide care and help manage scare resources during the pandemic.
MAiD is not driven by socioeconomic vulnerability or poor access to palliative care
A new study of people who received medical assistance in dying (MAiD) in Ontario found that about three-quarters were cared for by palliative care practitioners at the time of their request for MAiD, and MAiD recipients were younger, wealthier and more likely to be married than the general population at time of death.
Palliative vs. standard care for Parkinson's disease
This randomized clinical trial that included 210 patients with Parkinson's disease and related disorders and 175 caregivers examined whether outpatient palliative care was associated with better patient or caregiver outcomes compared with standard care.
Palliative care in hospitals linked to decrease in use of ICU; treatment intensity
A new study shows that implementing hospital-based palliative care services in New York State reduces treatment intensity at the end of life for hospitalized patients.
Prediction system significantly increases palliative care consults
A trigger system powered by predictive analytics increased palliative care consultations by 75 percent after its implementation
More Palliative Care News and Palliative Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Warped Reality
False information on the internet makes it harder and harder to know what's true, and the consequences have been devastating. This hour, TED speakers explore ideas around technology and deception. Guests include law professor Danielle Citron, journalist Andrew Marantz, and computer scientist Joy Buolamwini.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at     You can read The Transition Integrity Project's report here.