Author(s): Braus N, Campbell TC, Kwekkeboom KL, Ferguson S, Harvey C,
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Abstract PURPOSE: To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes. METHODS: Prospective, before-and-after interventional study enrolling patients with high risk of mortality, morbidity, or unmet palliative care needs in a 24-bed academic intensive care unit (ICU). The intervention involved a palliative care clinician interacting with the ICU physicians on daily rounds for high-risk patients. RESULTS: One hundred patients were enrolled in the usual care phase, and 103 patients were enrolled during the intervention phase. The adjusted likelihood of a family meeting in ICU was 63\% higher (RR 1.63, 95\% CI 1.14-2.07, p = 0.01), and time to family meeting was 41\% shorter (95\% CI 52-28\% shorter, p < 0.001). Adjusted ICU length of stay (LOS) was not significantly different between the two groups (6\% shorter, 95\% CI 16\% shorter to 4\% longer, p = 0.22). Among those who died in the hospital, ICU LOS was 19\% shorter in the intervention (95\% CI 33-1\% shorter, p = 0.043). Adjusted hospital LOS was 26\% shorter (95\% CI 31-20\% shorter, p < 0.001) with the intervention. Post-traumatic stress disorder (PTSD) symptoms were present in 9.1\% of family respondents during the intervention versus 20.7\% prior to the intervention (p = 0.09). Mortality, family depressive symptoms, family satisfaction and quality of death and dying did not significantly differ between groups. CONCLUSIONS: Proactive palliative care involvement on ICU rounds for high-risk patients was associated with more and earlier ICU family meetings and shorter hospital LOS. We did not identify differences in family satisfaction, family psychological symptoms, or family-rated quality of dying, but had limited power to detect such differences.
This article was published in Intensive Care Med
and referenced in Journal of Palliative Care & Medicine