Goals of care and palliative care practices in critically ill patients: A multicentre, binational, point prevalence study

BACKGROUND: There are limited cross-sectional data regarding goals of care documentation and palliative care practices in intensive care units (ICUs). This point prevalence study describes documentation of goals of care, approach to limitation of life-sustaining therapies, and palliative care practices in Australian and New Zealand ICUs. OBJECTIVES: (i) to describe documentation of goals of care of patients in the ICU and (ii) to describe palliative care practices in the ICU. METHODS: multicentre, binational, point prevalence study was conducted. All adult patients admitted to 49 participating ICUs at a prespecified date and time were identified and followed up for 24 h. Primary outcome measures were documentation of goals of care, treatment limitations, and palliative care practices. RESULTS/FINDINGS: 649 patients were observed from 49 participating ICUs. Goals of care were documented in 444 out of 649 (68%) patients, with 74% (327/444) of these patients for full active management. Ninety-six patients (21%) were for active management with limitation of life-sustaining therapies, and 21 (5%) patients were for palliative care only. The most frequently withheld treatments were cardiopulmonary resuscitation (90%, 86/96), followed by invasive ventilation (50%, 48/96). ICU mortality was highest in patients who received palliative care only (71%, 15/21), followed by those who were for active management with limitation of life-sustaining therapies (27%, 26/96). Twenty-six (8%) patients who were for full active management died in the ICU. Among the patients who were for palliative care only, analgesics and sedatives were administered in 67% and 52% of these patients, respectively. Of the 49 participating ICUs, 29 (59%) had a defined policy or protocol for bereavement follow-up. CONCLUSIONS: One-third of patients admitted to the ICU did not have goals of care documented on the study day. Most patients were discharged alive from the ICU. Withholding of certain life-sustaining therapies was associated with increased mortality. Patients who received palliative care in the ICU were provided with symptom management, and bereavement follow-up was provided in two-thirds of participating ICUs.