Choosing and Using Screening Criteria for Palliative Care Consultation in the ICU

Abstract

Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.

Use of Improving Palliative Care in the ICU (Intensive Care Unit) Guidelines for a Palliative Care Initiative in an ICU

“…15 The actual role of the consult service varies with local customs and culture, but the focus tends to be on issues such as goal setting, challenging care decisions regarding the use of life-sustaining treatments, withdrawal of unwanted life-prolonging therapies, do-not-resuscitate designation, conflict resolution, and transitional care planning. 15,20,31,32 The practice guidelines all started with choosing a model for palliative care incorporation into an ICU. The literature noted two major models of palliative care: the "consultative model" and the "integrative model."…”

“…As a result, two groups published a systematic review and a set of CPGs designed to address the selection of trigger criteria. Nelson et al 31 reviewed the use of screening criteria as a mechanism for engaging palliative care consults in the ICU. They determined that the use of specific criteria …”

“…31 Weissman and Meier 20 recommended development of two checklists, divided into primary and secondary criteria, to facilitate ease of implementation. Selection of the indicators for these checklists was based on national standards, research findings, and expert opinions from the consensus panel.…”

“…Nelson et al 31 followed up on earlier reports and recommendations from the IPAL-ICU project. They published a subsequent systematic review to look at the use of recommended screening criteria as a mechanism for engaging palliative care consultants, to assist with care of critically ill patients and their families in the ICU.…”

Fatores preditores de óbito em Unidade de Terapia Intensiva: contribuição para a abordagem paliativista

“…This information was obtained from the patient's family members (18) . Patients with previous diagnosis of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), cirrhosis with Child-Pugh C, chronic renal failure, cerebral vascular disease with functional dependence, feeding difficulty and/or the presence of advanced malignant neoplasia were considered as life-threatening conditions (19) . The severity of the acute disease was verified according to the Simplified Acute Physiology Score (SAPS III), collected from the patient's medical chart.…”