End-of-Life care can be improved; Critical Care Journal supplement
devoted to end-of-life care
DES PLAINES, Ill., Nov. 1 /U.S. Newswire/ -- Researchers have
evaluated improvements in the end-of-life care in intensive care
units (ICU) and have shared their findings in a special supplement
to Critical Care Medicine, the journal of the Society of Critical
Care Medicine. The supplement is dedicated entirely to end-of-life
care in the critical care setting.
"Improving the quality of care received by critically ill
and dying patients in the ICU remains an ongoing challenge,"
explains guest co-editor J. Randall Curtis, M.D., M.P.H.,
professor of medicine at the University of Washington in
Seattle. "Over the past five years there have been
encouraging signs of improvement in end-of-life care in the
ICU. Interventions have been developed, evaluated, and
published to improve the care that patients and their
families receive relating to the end of life in the ICU."
Approximately one in five deaths in the United States now occurs in
the ICU or shortly after receiving intensive care. The ICU is likely
to remain an important setting for end-of-life care because of the
severity of illness in these patients and because many families and
patients with chronic, life-limiting diseases will opt for a trial
of intensive care.
Critical care researchers are taking the lessons learned from
previous observational studies and using them to develop and test
generalizable interventions that improve the quality of ICU end-
of-life care. The Critical Care Medicine supplement includes 20
articles evaluating end-of-life issues, including palliative care in
the ICU, attitudes toward withholding and withdrawing life support,
ethical and legal issues, quality indicators, communications between
physicians and nurses, interventions for children at the end of
life, and promising future directions.
"We believe this supplement documents the tremendous progress that
has been made in the past decade and represents the state of the art
for assessing and improving end-of-life care in the ICU," comments
guest co-editor Mitchell Levy, M.D., professor of medicine at Brown
University School of Medicine in Providence, R.I.
Quality End-of-Life Palliative Care
A paper by Ira Byock, M.D., a professor at Dartmouth Medical School
and director of palliative medicine at Dartmouth Hitchcock Medical
Center in Lebanon, N.H., describes recent developments in the
integration of palliative and critical care.
Palliative and end-of-life care in the ICU is an appropriate and
under-developed area for quality assessment and improvement,
according to Richard Mularski, M.D., M.S.H.S., from the Veterans
Affairs Greater Los Angeles Healthcare System. Dr. Mularski and a
number of the other contributors to this supplement combined forces
to develop an article that provides a practical framework for
examining processes of care that might be quality measures. This
article proposes 18 candidate quality measures that could be
implemented in ICUs tomorrow. Dr. Mularski and colleagues suggest
that further work also is needed to demonstrate such measures are
valid and reliable.
End-of-Life Interventions
Considering that 20 percent of deaths in the United States occur in
ICUs and that the quality of life in an ICU at the end of life often
is rated as poor, improving the quality of end-of- life care in this
setting is seen as an important endeavor. In an article on measuring
quality improvement, Dr. Curtis and co- author Ruth A. Engelberg,
Ph.D., from the University of Washington in Seattle, examine data
supporting potential process and outcome measures that could be used
to evaluate the success of interventions designed to improve
end-of-life care in the ICU.
Dr. Levy notes that this supplement documents a need for additional
research and quality improvement in order to realize the potential
for improving the care delivered to critically ill patients at the
end of life as well as the care provided to their families.
The supplement resulted from the conference, "Improving the Quality
of End-of-Life Care in the ICU: Interventions that Work," which was
funded by the Robert Wood Johnson Foundation and hosted by the
Society of Critical Care Medicine on February 17-19, 2006, in Miami,
Fla.