Patterns of palliative care service consultation in a sample of critically ill ICU patients at high risk of dying

Abstract

Objective: Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying.

Background: Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes.

Methods: From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation.

Results: About half (773/1440 [54%]) were at high risk of dying or died, 73 (9.4%) of whom received palliative care consultation. On average, referral occurred after 62% of the ICU stay had elapsed. Primary reason for consult was clarification of goals of care (52/73 [72.2%]).

Conclusions: Among MV ICU patients at high risk of dying, palliative care service consultation occurs late and infrequently, suggesting a role for earlier palliative care.

Keywords: Critical care; End-of-life care; Palliative care; Patient-centered outcomes; Quality of health care.