The Journal of the American Medical Association (JAMA), released a new edition this month called Death, Dying and End of Lie Viewpoints. The edition discusses several issues related to hospice and palliative care including assisted dying, ICU use at the end of life, and hospice policy.
Alex Smith, co-founder of ePrognosis and the GeriPal blog, put together a great review of all of the articles in the edition here. In particular, his review of the article on how to appropriately use ICU's for end of life care was thought provoking. The article offer's 5 ways to improve end of life care in the ICU.
They propose 5 strategies to improve use of the ICU for seriously ill and dying patients:
Reduce inappropriate ICU admissions. Discuss ICU type care in goals of care conversations. Favorite part: reduce the number of ICU beds. Make them scarce and clinicians will be more responsible and careful in who they admit.
Re-evaluate goals of care during the ICU stay. The ICU stay should be viewed as a time limited trial, not an open ended commitment. Yes!
Improve shared decision making with patients and families. Love is not enough. Compassion is not enough. Clinicians need training in how to have these conversations. This is a skill, not an emotion. Heck yeah!
Improve consensus building among the entire clinical team. Agree on prognosis. Get on the same page. Don't send mixed messages.
Make ICUs more humane. "It is time to challenge the notion that ICU care includes pain, incapacitation, and mental anguish as inherent and unavoidable adverse effects." ICU care and good palliative care are not incompatible. They should go hand in hand. Right on!