Integrating palliative care into the ICU: a lasting and developing legacy

Excerpt

From the inception of the intensive care unit (ICU), end-of-life care has always been delivered in this setting due to the high severity of illness of the patients. Approximately 50 years ago, there was a developing interest in improving the quality of end-of-life care in the ICU giving rise to such landmark studies as SUPPORT and documenting the poor quality of end-of-life care in ICUs and hospitals [1]. The concept of palliative care in the ICU did not emerge until late 1990’s or early 2000’s, perhaps because the earlier years of intensive care were more focused on physiological support and because patients’ family members were often excluded from the ICU. Palliative care includes end-of-life care, but is broader than only end-of-life care incorporating “an approach that improves the quality of life of patients and their families who are facing… life-threatening illness {to} prevent and relieve suffering through the early identification, correct assessment and treatment of… problems, whether physical, psychosocial or spiritual.” [2]. By this definition, palliative care is relevant for many patients with critical illness and their family members. Further, there has been an important distinction drawn between the primary palliative care that is provided by any clinician caring for a patient with life-threatening illness and the specialty palliative care provided by those with specialty training in palliative care [3]. …