Table 5

Ways of Improving Palliative Care in the ICU

How Can We Improve our Abilities and our Consistency in Assessing and Treating Pain and Suffering?

Open discussions involving all members of the health care team and family, consulting and sharing when faced with difficult cases, improvements in education and research are needed. The development of a process to review our performance in palliative care within each ICU and national consensus guidelines will also improve our skill in assessing pain and suffering and improve our abilities to relieve it at the end-of-life.

Support for the Intensive Care Unit Staff

The importance of psychological and emotional support for the ICU staff involved in palliating a dying patient is frequently overlooked. Developing a supportive working group, open communication and regular debriefings among members of the ICU team is crucial. The ICU social worker, pastoral care representative and, within the hospital, the departments of psychiatry and psychology may also be very helpful in enabling the ICU staff to continue to provide good palliative care.

Palliative Care Medicine Consultation

Currently a formal Palliative Care consult is rarely requested during the withholding and withdrawal of life support. If the expertise exists within the ICU, such a consult is not required. A Palliative Care Medicine consultation could be useful to: 1) treat symptoms that are difficult to control, 2) treat difficult pain syndromes, 3) provide guidance on the use of adjuncts that we, as Intensivists, use infrequently in the dying process, 4) provide guidance when using analgesics/sedatives infrequently administered, 5) help when significant psychological issues within the family or health care team are evident, 6) provide guidance in ICUs where the practices of withholding/withdrawal of care is infrequent, 7) help ease the patient's transfer to the ward if he/she survives the withholding/withdrawal process, and 8) provide ongoing help in relieving pain and suffering when death is protracted.

Hawryluck et al. BMC Medical Ethics 2002 3:3   doi:10.1186/1472-6939-3-3

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