Palliative care in the intensive care unit: barriers, advances, and unmet needs.
The concept that critical illness and terminal illness are necessarily distinct entities has given way to the understanding that they often exist on the same spectrum. Consequently, there is growing consensus that palliative treatment must coexist with attempts at restorative treatment in the intensive care unit (ICU). Palliative care in the ICU has evolved from a relatively one-dimensional construct of terminal sedation in dying patients to a multidisciplinary field addressing symptom control, physician-patient-family communication,spiritual needs, and the needs of health care providers. As ongoing research efforts yield new insights, our ability to practice evidence-based palliative care in the ICU will grow, and new avenues for improvement will become evident.
White
Douglas B
DB
Division of Pulmonary and Critical Care Medicine and Program in Medical Ethics, University of California, 521 Parnassus Avenue, Suite C-126, San Francisco, CA 94143-0903, USA. dwhite@medicine.ucsf.edu
Luce
John M
JM
D032722:Advance Care Planning / Q000941:ethics / Q000458:organization & administration; D001293:Attitude to Death; D001294:Attitude to Health; D002985:Clinical Protocols; D003142:Communication; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration* / Q000523:psychology; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005190:Family / Q000523:psychology; D005544:Forecasting; D006301:Health Services Needs and Demand / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D010166:Palliative Care / Q000941:ethics / Q000458:organization & administration* / Q000523:psychology; D010348:Patient Care Team / Q000458:organization & administration; D010686:Philosophy, Medical; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011368:Professional-Family Relations; D019984:Quality Indicators, Health Care; D029181:Spirituality; D017749:Total Quality Management / Q000458:organization & administration; D028761:Withholding Treatment / Q000941:ethics