Publication details

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Authors	KESECIOGLU Jozef RUSINOVA Katerina ALAMPI Daniela ARABI Yaseen M BENBENISHTY Julie BENOIT Dominique BOULANGER Carole CECCONI Maurizio COX Christopher MARJEL van Dam VAN DIJK Diederik DOWNAR James EFSTATHIOU Nikolas ENDACOTT Ruth GALAZZI Alessandro FIONA van Gelder GERRITSEN Rik T GIRBES Armand HAWYRLUCK Laura HERRIDGE Margaret HUDEC Jan KENTISH-BARNES Nancy KERCKHOFFS Monika LATOUR Jos M MALÁSKA Jan MARRA Annachiara MEDDICK-DYSON Stephanie MENTZELOPOULOS Spyridon MER Mervyn METAXA Victoria MICHALSEN Andrej MISHRA Rajesh MISTRALETTI Giovanni MARGO van Mol MORENO Rui NELSON Judith SUNER Andrea Ortiz PATTISON Natalie PROKOPOVÁ Tereza PUNTILLO Kathleen PUXTY Kathryn QAHTANI Samah Al RADBRUCH Lukas RODRIGUEZ-RUIZ Emilio SABAR Ron SCHALLER Stefan J SIDDIQUI Shahla SPRUNG Charles L UMBRELLO Michele VERGANO Marco ZAMBON Massimo ZEGERS Marieke DARMON Michael AZOULAY Elie
Year of publication	2024
Type	Article in Periodical
Magazine / Source	Intensive care medicine
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://link.springer.com/article/10.1007/s00134-024-07579-1
Doi	http://dx.doi.org/10.1007/s00134-024-07579-1
Keywords	Intensive care unit; End of life; GRADE; Cultural variations; Decision-making; Palliative care; Communication; Family-centered care; Conflict management
Description	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.