Palliative Care in the Trauma and Surgical Critical Care Settings: A Narrative Review

Abstract

Background We aimed to conduct a narrative review of available literature to understand the use of palliative care in the trauma and surgical critical care setting. Methods PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the use of palliative care in the trauma and surgical critical care setting. The search included all studies published through January 9th, 2022. The risk of bias of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Outcomes were summarized in tables and synthesized qualitatively. Results A total of 22 studies were included in this review. Key elements of successful palliative care include communication, shared decision-making, family involvement, pain control, establishing a patient’s prognosis, and end-of-life management. Approaches to implementation based upon these key elements include best-case/worst-case scenarios, consultation trigger systems, and integrated institutional palliative care programs. Palliative care may reduce hospital length of stay, improve symptom management, and increase patient satisfaction, but the impact on mortality is unclear. Conclusion The core elements of palliative care have been identified and palliative care has been shown to improve outcomes in trauma and surgical critical care. However, the approaches for implementation still require development. The underutilization of palliative care for trauma patients reveals the need for refining criteria for use of palliative care and improvement in the education of surgical critical care teams to provide primary palliative care services.

Preoperative care for patients in terminal stage of disease from the perspective of nurses

“…Considerando que a Teoria Fundamentada nos Dados se refere ao polo metodológico da pesquisa, o processo interpretativo dos resultados teve por base conceitual o conceito de cirurgia paliativo e os mesmos princípios dos cuidados paliativos (1,(3)(4)(9)(10) .…”

“…Embora a paliação possa ocasionar aumento da sobrevivência, não é pertinente eleger um procedimento paliativo com base unicamente no desejo desse aumento da sobrevida (1,3) . A falta de clareza na indicação de algumas cirurgias para pacientes em estágio terminal de doença com indicação de cirurgias eletivas que não são, muitas vezes, paliativas, mas, curativas, pode ser um conflito quando não há discussão multidisciplinar ou quando realmente há tratamentos cirúrgicos distanásicos, resultantes do compromisso profissional em salvar a vida do paciente incessantemente, atrelado ao sentimento de derrota em face da morte do paciente (1,(9)(10)(11) .…”

“…A indicação de um procedimento cirúrgico para pacientes em estágio terminal de doença deveria sempre passar pela mediação de uma equipe consultiva de cuidados paliativos (9,11) . Em alguns casos, a mediação chega a ser indispensável, de forma que todos os envolvidos se aproximem de um consenso acerca da decisão tomada.…”

The differences between palliative care and hospice care

“…1,3 Primary palliative care is administered by a provider with basic knowledge of palliative care, typically the patient's primary care provider. 5 Referring patients to a healthcare provider who specializes in palliative care is known as secondary or specialty palliative care. 6 The need for palliative care increases as the number of individuals with chronic conditions rises.…”

“…Palliative care is defined as “specialized medical care for patients living with a serious illness.”1,3 Primary palliative care is administered by a provider with basic knowledge of palliative care, typically the patient's primary care provider 5. Referring patients to a healthcare provider who specializes in palliative care is known as secondary or specialty palliative care 6.…”