ORCID
- Jos M. Latour: 0000-0002-8087-6461
Abstract
The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.
Publication Date
2024-01-01
Publication Title
Intensive Care Medicine
Volume
50
Issue
11
ISSN
0342-4642
Keywords
Communication, Conflict management, Cultural variations, Decision-making, End of life, Family-centered care, GRADE, Intensive care unit, Palliative care
First Page
1740
Last Page
1766
Recommended Citation
Kesecioglu, J., Rusinova, K., Alampi, D., Arabi, Y., Benbenishty, J., Benoit, D., Boulanger, C., Cecconi, M., Cox, C., van Dam, M., van Dijk, D., Downar, J., Efstathiou, N., Endacott, R., Galazzi, A., van Gelder, F., Gerritsen, R., Girbes, A., Hawyrluck, L., Herridge, M., Hudec, J., Kentish-Barnes, N., Kerckhoffs, M., Latour, J., Malaska, J., Marra, A., Meddick-Dyson, S., Mentzelopoulos, S., Mer, M., & Metaxa, V. (2024) 'European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit', Intensive Care Medicine, 50(11), pp. 1740-1766. Available at: 10.1007/s00134-024-07579-1
