CHALLENGES OF PROVIDING PALLIATIVE CARE IN A CRITICAL CARE SETTING

Abstract

Introduction: Changing demographics and medical advances have led to increased demand for beds in Intensive care units (ICU). UK end of life care strategy recommends delivery of high quality service in all locations including acute hospitals. Objective(s): To retrospectively review all referrals over a six-year period from general and specialist ICU to hospital palliative care team (HPCT) of a large teaching hospital in UK. The objectives were to assess reasons for referral, outcome and challenges encountered. Method(s): Information was extracted from Infoflex, an electronic patient database that captures details of referral, diagnosis, patient assessment and HPCT interventions. Result(s): One hundred forty-four patients (77 male, 68 female) median age 59.3 (range 22-94) from critical care facilities were referred to HPCT over 6 year period. Ninety had a diagnosis of malignancy. The reasons for referral included symptom control, support with withdrawal of therapy and management of terminal care including support to carer. 96/144 patients died. Forty-nine died in ICU. The HPCT was able to facilitate and achieve preferred place of death outside acute hospital for 23 patients. The biggest challenge was communication as combination of critical illness and invasive interventions often diminished the capacity of patients to make decisions. Discontinuity of care and accepting the shift in goals from intensive treatment to palliative care was emotionally difficult for staff and family. Conclusion(s): Despite the challenges, it is possible and appropriate to give compassionate palliative care to dying patients in critical care setting through good interdisciplinary team working and communication adopting a proactive approach.