End-of-life Care Practices in a Tertiary ICU in Kerala, South India

INTRODUCTION: End-of-life care (EOLC) is an essential yet underdeveloped aspect of medical practice in India, particularly in intensive care units (ICUs). It aims to provide a dignified death by prioritizing comfort and quality of life over curative treatments. The study examines EOLC practices in a tertiary care ICU in Kerala, shedding light on clinical trends and cultural influences that shape these critical decisions. OBJECTIVES: To estimate the prevalence of EOLC decisions among ICU admissions. To determine the proportion of EOLC cases within total ICU mortality. To analyze the clinical profiles and outcomes of patients who opted for EOLC. MATERIALS AND METHODS: This prospective observational study was conducted in the medical ICU of Pushpagiri Medical College, Kerala, from October 2023 to June 2024. A total of 554 adult patients were included based on predefined inclusion and exclusion criteria. Data were collected using structured proformas, APACHE II, and SOFA score assessments. The study recorded demographic details, comorbidities, EOLC decisions, and patient outcomes, analyzed using SPSS software. RESULTS: Among 554 patients, 8.3% opted for EOLC. Of these, 41.31% decisions involved withholding intubation, 21.73% involved withholding escalation of treatment, 32.61% involved care withdrawal, and 4.35% were DNR orders. ICU mortality was 9.3%, with 40.39% of deaths occurring among EOLC patients. The mean age of EOLC patients was 67.3 years, predominantly in the 60–80 age group. Key comorbidities included diabetes (45.7%), hypertension (50%), and chronic respiratory diseases (30.4%). Sepsis was the most common diagnosis (56.5%). Among EOLC patients, 76.09% died within 30 days, with an average time to death of 4.03 days. Decisions were often influenced by factors such as functional disability (45.65%) and family preferences (32.6%). Sons/daughters provided consent in 65.21% of cases. CONCLUSION: EOLC decisions in this ICU highlight the complexities of balancing medical futility, cultural factors, and patient autonomy. Though 8.3% prevalence of EOLC indicates gradual adoption, significant barriers remain. Enhanced awareness, physician training, and clearer legal frameworks are essential to promote compassionate EOLC practices in India.