title: Using Technology to Create a More Humanistic Approach to Integrating Palliative Care into the Intensive Care Unit.
abstract: A decade ago, the major obstacles to integration of palliative care into the intensive care unit (ICU) were the limited number of providers trained in palliative care, an immature evidence base, and a lack of appreciation for the importance of palliative care in the ICU. In 2016, the palliative care workforce has expanded markedly and there is growing appreciation of the benefits of palliative care, whether provided by a generalist (intensivist, nurse, social worker) or palliative care specialist. However, there is evidence that the quality of ICU-based palliative care is often suboptimal. A major barrier to more broadly addressing this quality problem is the lack of scalable ICU-based palliative care models that use technology to deliver efficient, collaborative palliative care in the ICU setting to the right patient at the right time. To address these challenges, we first review strengths and limitations of current care models as the basis for our novel conceptual framework that uses the electronic health record as a platform on which external innovations can be built, including: (1) screening for patients at risk for poor outcomes, (2) integrating patient- and family-reported needs, (3) personalizing care, and (4) directing generalist versus specialist triage algorithms. In the approaches considered, we describe current challenges and propose specific solutions that use technology to improve the quality of the human interaction in a stressful, complex environment.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, and.|2 Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina; and.
authors.forename: Christopher E
authors.identifier: http://orcid.org/0000-0002-4486-0681
authors.initials: CE
authors.lastname: Cox
authors.affiliation: 3 Cambia Palliative Care Center of Excellence, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000465:Algorithms; D020811:Biomedical Technology; D016638:Critical Illness; D057286:Electronic Health Records; D006280:Health Workforce; D007362:Intensive Care Units / Q000458:organization & administration*; D010166:Palliative Care / Q000458:organization & administration*; D018802:Patient-Centered Care; D011379:Prognosis; D014218:Triage
keywords: critical illness; palliative care; patient centeredness; patient-reported outcomes