Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes

Overview

Journal J Palliat Med

Specialty Critical Care

Date 2017 Apr 6

PMID 28379812

Citations 22

Authors

Rebecca A Aslakson

Lynn F Reinke

Christopher Cox

Erin K Kross

Roberto P Benzo

J Randall Curtis

Affiliations

Soon will be listed here.

Abstract

Background: Palliative care is a medical specialty and philosophy of care that focuses on reducing suffering among patients with serious illness and their family members, regardless of disease diagnosis or prognosis. As critical illness or moderate to severe pulmonary disease confers significant disease-related symptom burdens, palliative care and palliative care specialists can aid in reducing symptom burden and improving quality of life among these patients and their family members.

Objective: The objective of this article is to review the existing gaps in evidence for palliative care in pulmonary disease and critical illness and to use an interdisciplinary working group convened by the National Institutes of Health and the National Palliative Care Research Center to develop a research agenda to address these gaps.

Methods: We completed a narrative review of the literature concerning the integration of palliative care into pulmonary and/or critical care. The review was based on recent systematic reviews on these topics as well as a summary of relevant articles identified through hand search. We used this review to identify gaps in current knowledge and develop a research agenda for the future.

Results: We identified key areas of need and knowledge gaps that should be addressed to improve palliative care for patients with pulmonary and critical illness. These areas include developing and validating patient- and family-centered outcomes, identifying the key components of palliative care that are effective and cost-effective, developing and evaluating different models of palliative care delivery, and determining the effectiveness and cost-effectiveness of palliative care interventions.

Conclusions: The goal of this research agenda is to encourage researchers, clinicians, healthcare systems, and research funders to identify research that can address these gaps and improve the lives of patients with pulmonary and critical illness and their family members.

Citing Articles

Early Palliative Care in the Emergency Department: A Concept Clarification.

Counts K, Lasiter S J Caring Sci. 2024; 13(3):148-157.

PMID: 39624609 PMC: 11608405. DOI: 10.34172/jcs.33578.

"It's all about setting the stage." The nurse facilitator trial: perceived outcomes and implementation issues. A qualitative study among ICU clinicians and nurse facilitators.

Renet A, Azoulay E, Reignier J, Cariou A, Renault A, Huet O Intensive Care Med. 2024; 50(10):1657-1667.

PMID: 39158706 DOI: 10.1007/s00134-024-07589-z.

Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU: Clinician Perceptions.

Bryan A, Reich A, Norton A, Campbell M, Schwartzstein R, Cooper Z CHEST Crit Care. 2024; 2(2).

PMID: 38957855 PMC: 11218830. DOI: 10.1016/j.chstcc.2024.100051.

Characteristics of "do not resuscitate" orders among elderly patients receiving mechanical ventilation in the intensive care unit in Taiwan.

Chen P, Ho C, Lin Y, Chang M, Liao K Front Med (Lausanne). 2024; 11:1373726.

PMID: 38846140 PMC: 11153661. DOI: 10.3389/fmed.2024.1373726.

Critical Issues in the Management of Agitation, Aggression, and End-of-Life in Delusional Disorder: A Mini-Review.

Gonzalez-Rodriguez A, Seeman M, Roman E, Natividad M, Pages C, Ghigliazza C Healthcare (Basel). 2023; 11(4).

PMID: 36832992 PMC: 9956049. DOI: 10.3390/healthcare11040458.

References

Swoboda S, Lipsett P . Impact of a prolonged surgical critical illness on patients' families. Am J Crit Care. 2002; 11(5):459-66. View

Rocker G, Verma J . 'INSPIRED' COPD Outreach Program™: doing the right things right. Clin Invest Med. 2014; 37(5):E311-9. View

Cox C, Martinu T, Sathy S, Clay A, Chia J, Gray A . Expectations and outcomes of prolonged mechanical ventilation. Crit Care Med. 2009; 37(11):2888-94. PMC: 2766420. DOI: 10.1097/CCM.0b013e3181ab86ed. View

Mularski R, Reinke L, Carrieri-Kohlman V, Fischer M, Campbell M, Rocker G . An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis. Ann Am Thorac Soc. 2013; 10(5):S98-106. DOI: 10.1513/AnnalsATS.201306-169ST. View

Currow D, McDonald C, Oaten S, Kenny B, Allcroft P, Frith P . Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage. 2011; 42(3):388-99. DOI: 10.1016/j.jpainsymman.2010.11.021. View

Quill T, Abernethy A . Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013; 368(13):1173-5. DOI: 10.1056/NEJMp1215620. View

Campbell M, Guzman J . A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Crit Care Med. 2004; 32(9):1839-43. DOI: 10.1097/01.ccm.0000138560.56577.88. View

Hall R, Rocker G, Murray D . Simple changes can improve conduct of end-of-life care in the intensive care unit. Can J Anaesth. 2004; 51(6):631-6. DOI: 10.1007/BF03018408. View

. Optimum care for hopelessly ill patients. N Engl J Med. 1976; 295(7):362-4. DOI: 10.1056/NEJM197608122950704. View

10.

Weingaertner V, Scheve C, Gerdes V, Schwarz-Eywill M, Prenzel R, Bausewein C . Breathlessness, functional status, distress, and palliative care needs over time in patients with advanced chronic obstructive pulmonary disease or lung cancer: a cohort study. J Pain Symptom Manage. 2014; 48(4):569-81.e1. DOI: 10.1016/j.jpainsymman.2013.11.011. View

11.

Schneiderman L, Gilmer T, Teetzel H, Dugan D, Blustein J, Cranford R . Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA. 2003; 290(9):1166-72. DOI: 10.1001/jama.290.9.1166. View

12.

Batzlaff C, Karpman C, Afessa B, Benzo R . Predicting 1-year mortality rate for patients admitted with an acute exacerbation of chronic obstructive pulmonary disease to an intensive care unit: an opportunity for palliative care. Mayo Clin Proc. 2014; 89(5):638-43. PMC: 4702502. DOI: 10.1016/j.mayocp.2013.12.004. View

13.

Cox C, Docherty S, Brandon D, Whaley C, Attix D, Clay A . Surviving critical illness: acute respiratory distress syndrome as experienced by patients and their caregivers. Crit Care Med. 2009; 37(10):2702-8. PMC: 2771584. DOI: 10.1097/CCM.0b013e3181b6f64a. View

14.

Campbell M, Guzman J . Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest. 2003; 123(1):266-71. DOI: 10.1378/chest.123.1.266. View

15.

Scheunemann L, McDevitt M, Carson S, Hanson L . Randomized, controlled trials of interventions to improve communication in intensive care: a systematic review. Chest. 2010; 139(3):543-554. DOI: 10.1378/chest.10-0595. View

16.

Puntillo K, Arai S, Cohen N, Gropper M, Neuhaus J, Paul S . Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med. 2010; 38(11):2155-60. PMC: 3377582. DOI: 10.1097/CCM.0b013e3181f267ee. View

17.

Murray S, Kendall M, Boyd K, Sheikh A . Illness trajectories and palliative care. BMJ. 2005; 330(7498):1007-11. PMC: 557152. DOI: 10.1136/bmj.330.7498.1007. View

18.

Detering K, Hancock A, Reade M, Silvester W . The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010; 340:c1345. PMC: 2844949. DOI: 10.1136/bmj.c1345. View

19.

Curtis J, Nielsen E, Treece P, Downey L, Dotolo D, Shannon S . Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med. 2010; 183(3):348-55. PMC: 3056230. DOI: 10.1164/rccm.201006-1004OC. View

20.

Schneiderman L, Gilmer T, Teetzel H . Impact of ethics consultations in the intensive care setting: a randomized, controlled trial. Crit Care Med. 2001; 28(12):3920-4. DOI: 10.1097/00003246-200012000-00033. View