title: From persistence to palliation:  limiting active treatment in the ICU.
abstract: OBJECTIVE
  End-of-life care and communication deficits are important sources of conflicts within ICU teams and with patients or families. This narrative review describes recent studies on how to improve palliative care and surrogate decision-making in ICUs and compares the results with previously published literature on this topic.
  
  
  RESULTS
  Awareness and use of end-of-life recommendations is still low. Education about end-of-life is beneficial for end-of-life decisions. Residency and nurses training programmes start to integrate palliative care education in critical care. Integration of palliative care consults is recommended and probably cost-effective. Projects that promote direct contact of care team members with patients/families may be more likely to improve care than educational interventions for caregivers only. The family's response to critical illness includes adverse psychological outcome ('postintensive care syndrome-family'). Information brochures and structured communication protocols are likely to improve engagement of family members in surrogate decision-making; however, validation of outcome effects of their use is needed.
  
  
  CONCLUSIONS
  Optimizing palliative care and communication skills is the current challenge in ICU end-of-life care. Intervention strategies should be interdisciplinary, multiprofessional and family-centred in order to quickly reach these goals.
authors.affiliation: Department of Internal Medicine, Academic Teaching Hospital, Central Hospital of Bolzano, Bolzano, Italy. christian.wiedermann@asbz.it
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Wiedermann
authors.forename: Georg F
authors.initials: GF
authors.lastname: Lehner
authors.forename: Michael
authors.initials: M
authors.lastname: Joannidis
mesh_terms: D003142:Communication; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D010166:Palliative Care; D013727:Terminal Care