Tuesday, October 24, 2006

Supplement to Critical Care Medicine: ICU and Palliative Care

Critical Care Medicine has dedicated the supplement issue to ICU collaboration with Palliative Care services. Many of the articles are written by key players in ethics and palliative care including Truog, Schneiderman, Billings and Byock. The articles are not free full text access unfortunately, but they do cover some important areas if this is your interest.

One interesting new graphic to describe the differences and similarities of the ICU and Palliative Care came from the article by Byock, "Improving palliative care in intensive care units: Identifying strategies and interventions that work"

















Most basically, intensivists and palliative care professionals both care for the sickest patients in the healthcare system. As with patients in an ICU, those referred for palliative care consultation or admitted to hospice programs have life-threatening conditions, often involving multiple organ system failure or insufficiency. Critical care and palliative care patients typically are taking 8-15 prescribed medications, despite efforts to avoid polypharmacy and drug-–drug interactions. Although the primary foci for palliative care and critical care may initially seem divergent, on inspection, strong concordance of therapeutic values and goals is apparent. Indeed, the primary goal of each discipline is the secondary goal of the other.

This says elegantly what I have always tried to advocate for to patients, families, nurses, managers, and attendings in the ICU. There are a lot of key articles in here dedicated to implementation of Pall Care programs in the ICU, so if you are a 'palliatist' on your way to creating a new program, these are key articles you want to share with your colleagues in the ICU since it comes from a journal dedicated to ICU care.

Also for those of you who are starting palliative care programs I would like to share this little anecdote from my day today. Our palliative care census at a local community hospital (200 beds) was at 6 this morning. We received 5 consults today and set up 4 family meetings. Busy day. Two of the family meetings were with patients and families we had met 3 weeks ago and 6 months ago. Both families had shared they were glad and releived that we (palliative care) were involved again because they appreciated out whole-patient approach. They felt as if their loved one and their family were both treated with respect and that our team did an excellent job of sharing complex medical information. They both also said how that helped them match their goals to what the reality of the situation was without feeling pressured.

Now I am not trying to deomnstrate that I am a great doctor or that I have a great palliative care team. We have been in service at this hospital for 7 years and have developed this team over time. Days like this make it much easier to face the daily emotional strains of dealing with difficult ethical, medical and psychological situations. So if you are creating a palliative care team, are on a palliative care team, or working for a hospice agency, I want to share this appreciation with all of you, just in case you did not hear it from someone today, because these families were really thanking our approach to health and illness, life and death, and I know there are many more teams like mine out there. So keep up the good work.

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