End-of-life care in the intensive care unit: a research agenda.
BACKGROUND
The intensive care unit (ICU) represents a unique clinical setting in which mortality is relatively high and the professional culture tends to be one of "rescue therapy" using technological and invasive interventions. For these reasons, the ICU is an important environment for understanding and improving end-of-life care. Although there have been consensus statements and review articles on end-of-life care in the ICU, there is limited evidence on which to base an assessment of best practices for providing high-quality end-of-life care in this setting.


OBJECTIVE
To convene a Working Group of experts in critical care, palliative medicine, medical ethics, and medical law to address the question "What research needs to be done to improve end-of-life care to patients in the ICU?"


METHODS
Participants were identified for membership in the Working Group by purposive sampling within the fields of critical care medicine and nursing, palliative medicine, and medical ethics; others were chosen to represent social work and hospital chaplains. Through a process of breakout and plenary sessions, the group identified important questions that need to be addressed in the areas of defining the problem, identifying solutions, evaluating solutions, and overcoming barriers.


CONCLUSIONS
Outlining unanswered questions on end-of-life care in the ICU is a first step to providing the answers that will allow us to improve care to patients dying in the ICU. These questions also serve to focus clinicians and educators on the important areas for improving quality of care.
Rubenfeld
G D
GD
Division of Pulmonary and Critical Care Medicine, the Department of Medicine, University of Washington, Seattle, WA 98104-2499, USA. nodrog@u.washington.edu
Curtis
J R
JR
D001293:Attitude to Death; D003422:Critical Care / Q000592:standards* / Q000639:trends; D019317:Evidence-Based Medicine; D005260:Female; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D011787:Quality of Health Care; D014481:United States