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."
-end-


University of North Carolina Health Care

Related Palliative Care Articles:

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
Early palliative care for advanced lung cancer increases survival
Early palliative care is associated with better survival in patients with advanced lung cancer, according researchers with the Veterans Affairs Portland Health Care System and Oregon Health and Science University.
New staffing model for an integrated specialist team approach to palliative care
The Canadian Society of Palliative Care Physicians has developed a new staffing model for specialist palliative care teams that can deliver an optimal, integrated palliative care program.
Unique case of cannabis hyperemesis syndrome in palliative care
The medical use of cannabis is growing. Medical marijuana may improve symptoms including pain and anorexia.
Site of care may affect patients' access to palliative treatment
Studies have found that racial and ethnic minorities are less likely to receive end-of-life palliative care than their counterparts.
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

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.