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

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.

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Publication Details

Journal
Intensive Care Medicine
Published
2024-10-03
DOI
https://doi.org/10.1007/s00134-024-07579-1
Citations
85
Primary Topic
Palliative Care and End-of-Life Issues
Type
article
Field-Weighted Citation Impact
46.15

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article

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

Annachiara Marra, Kathryn A. Puxty, Jos M. Latour, Daniela Alampi et al.
85 citations
Intensive Care Medicine
Palliative Care and End-of-Life Issues
46.15
article

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

Annachiara Marra, Kathryn A. Puxty, Jos M. Latour, Daniela Alampi, Stefan Josef Schaller, Massimo Zambon, Charles L. Sprung, Carole Boulanger, Rik Gerritsen, Kathleen Puntillo, Marco Vergano, Armand R. J. Girbes, Julie Benbenishty, Samah Al Qahtani, Michele Umbrello, Christopher E. Cox, Diederik van Dijk, Jan Hudec, Tereza Prokopova, Ron Sabar, Victoria Metaxa, Jan Maláska, Alessandro Galazzi, Mervyn Mer, Margaret S. Herridge, James Downar, Fiona van Gelder, Jozef Kesecioğlu, Natalie Pattison, Ruth Endacott, Kateřina Rusínová, Nancy Kentish‐Barnes, Spyros D. Mentzelopoulos, Rui P. Moreno, Dominique Benoît, Lukas Radbruch, Élie Azoulay, Andrej Michalsen, Rajesh Chandra Mishra, Margo van Mol, Emilio Rodríguez‐Ruiz, Judith E. Nelson, Marieke Zegers, Maurizio Cecconi, Monika C. Kerckhoffs, Marjel van Dam, Stephanie Meddick-Dyson, Yaseen M. Arabi, Michael Darmon, Giovanni Mistraletti, Laura Hawyrluck, Shahla Siddiqui, Nikolas Efstathiou, Andrea Ortiz Suñer
article en
85 citations

Abstract

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.

Intensive Care MedicineVol. 50(11)
University of Udine (IT), Beth Israel Deaconess Medical Center (US), University Health Network (CA), Humanitas University (IT), University of Hertfordshire (GB), University of Lisbon (PT), Radboud University Nijmegen (NL), Imperial College Healthcare NHS Trust (GB), University of Ottawa (CA), Sun Yat-sen University (CN), University of Beira Interior (PT), Duke University (US), University of California, San Francisco (US), King's College London (GB), King Saud bin Abdulaziz University for Health Sciences (SA), University of Toronto (CA), University of Milan (IT), University of the Witwatersrand (ZA), Utrecht University (NL), Hebrew University of Jerusalem (IL), Universidade de Santiago de Compostela (ES), National and Kapodistrian University of Athens (GR), Université Paris Cité (FR), Curtin University (AU), Cornell University (US), Charles University (CZ), Masaryk University (CZ), Fudan University (CN), Toronto Western Hospital (CA), University Hospital Bonn (DE), Royal Devon & Exeter NHS Foundation Trust (GB), Johannesburg Hospital (ZA), Hadassah Medical Center (IL), Glasgow Royal Infirmary (GB), Ghent University Hospital (BE), Erasmus MC (NL), Medisch Centrum Leeuwarden (NL), Radboud University Medical Center (NL), Valencia Catholic University Saint Vincent Martyr (ES), University Medical Center Utrecht (NL), Rashtriya Raksha University (IN), Ghent University (BE), Humboldt-Universität zu Berlin (DE), Presbyterian Hospital (US), Hospital de São José (PT), Assistance Publique – Hôpitaux de Paris (FR), University Hospital Brno (CZ), King's College Hospital NHS Foundation Trust (GB), Hospital Arnau de Vilanova (ES), Ospedale San Giovanni Bosco (IT), Fondazione Europea Ricerca Biomedica (IT), East and North Hertfordshire NHS Trust (GB), Ziekenhuis Gelderse Vallei (NL), Azienda Ospedaliera Sant'Andrea (IT), Zhongshan Hospital (CN), The First Affiliated Hospital, Sun Yat-sen University (CN), Klinikum Konstanz (DE), Hôpital Saint-Louis (FR), Bruyère (CA), Instituto de Investigación Sanitaria de Santiago (ES), Amsterdam University Medical Centers (NL), Servicio Gallego de Salud (ES), General University Hospital in Prague (CZ), Azienda Ospedaliera Ospedale Civile di Legnano (IT), IRCCS Humanitas Research Hospital (IT), Imperial College London (GB), Netanya Academic College (IL), Hull York Medical School (GB), University of Naples Federico II (IT), University of Glasgow (GB), University of Birmingham (GB), Universidade Nova de Lisboa (PT), University of Plymouth (GB), Erasmus University Rotterdam (NL)
Pfizer, Bayer, Sanofi, Gilead Sciences, Alexion Pharmaceuticals, University of Washington, University of Pittsburgh, Società Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva, National Institute for Health and Care Research, Agence Nationale de la Recherche, Università degli Studi di Milano-Bicocca, Siemens, Masarykova Univerzita, Lékařská fakulta, Masarykova univerzita, European Society of Intensive Care Medicine, Gemeinsame Bundesausschuss, National Institutes of Health, National Heart, Lung, and Blood Institute, National Institute of Nursing Research
Openalex Percentile: Top 0%
Palliative Care and End-of-Life Issues
46.15
DOIOpen Access PDFOpenAlex
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