Critical Care at the End of Life

Abstract

Intensive care unit (ICU) admission is common among patients approaching the end of their lives from acute as well as chronic life-limiting conditions. ICU providers are expected to have basic palliative care skills integrated into their routine practice. Palliative care skills can be applied to all ICU patients, regardless of prognosis, and may improve patient- and family-centered end of life (EOL) care in the ICU. Consultative palliative care models may be required for more complex palliative care needs including symptom management, medical decision making, and bereavement. This review discusses integrative and consultative palliative care models and the role of triggers for palliative care consultation, particularly when they are tailored to the needs of individual ICUs. We then review the evidence for providing several palliative care domains in the ICU and some of the ethical considerations surrounding EOL care in the ICU. Finally, we highlight the importance of self-care and peer support groups to mitigate the risk of burnout for clinicians providing EOL care in the ICU.

Keywords

intensive care unit - end of life - palliative care - integrative - consultative - triggers - protocols - burnout

• References

• 1 Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press; 2014
• 2 Mularski RA, Heine CE, Osborne ML, Ganzini L, Curtis JR. Quality of dying in the ICU: ratings by family members. Chest 2005; 128 (1) 280-287
• 3 Mularski RA, Puntillo K, Varkey B , et al. Pain management within the palliative and end-of-life care experience in the ICU. Chest 2009; 135 (5) 1360-1369
• 4 Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med 2008; 36 (6) 1722-1728
• 5 Nelson JE, Mulkerin CM, Adams LL, Pronovost PJ. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care 2006; 15 (4) 264-271
• 6 Nelson JE, Puntillo KA, Pronovost PJ , et al. In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med 2010; 38 (3) 808-818
• 7 Teno JM, Clarridge BR, Casey V , et al. Family perspectives on end-of-life care at the last place of care. JAMA 2004; 291 (1) 88-93
• 8 Teno JM, Mor V, Ward N , et al. Bereaved family member perceptions of quality of end-of-life care in U.S. regions with high and low usage of intensive care unit care. J Am Geriatr Soc 2005; 53 (11) 1905-1911
• 9 Davidson JE, Powers K, Hedayat KM , et al; American College of Critical Care Medicine Task Force 2004-2005, Society of Critical Care Medicine. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35 (2) 605-622
• 10 Teno JM, Gozalo PL, Bynum JP , et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA 2013; 309 (5) 470-477
• 11 Angus DC, Barnato AE, Linde-Zwirble WT , et al; Robert Wood Johnson Foundation ICU End-Of-Life Peer Group. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 2004; 32 (3) 638-643
• 12 The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995; 274 (20) 1591-1598
• 13 Dy S. Ensuring Documentation of Patients' Preferences for Life-Sustaining Treatment: Brief Update Review in Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville, MD: Agency for Healthcare Research and Quality; 2013
• 14 Nelson JE, Angus DC, Weissfeld LA , et al; Critical Care Peer Workgroup of the Promoting Excellence in End-of-Life Care Project. End-of-life care for the critically ill: a national intensive care unit survey. Crit Care Med 2006; 34 (10) 2547-2553
• 15 Hinkle LJ, Bosslet GT, Torke AM. Factors associated with family satisfaction with end-of-life care in the ICU: a systematic review. Chest 2015; 147 (1) 82-93
• 16 Wall RJ, Engelberg RA, Gries CJ, Glavan B, Curtis JR. Spiritual care of families in the intensive care unit. Crit Care Med 2007; 35 (4) 1084-1090
• 17 Weissman DE, Morrison RS, Meier DE. Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations. J Palliat Med 2010; 13 (2) 179-184
• 18 Beernaert K, Deliens L, Vleminck A , et al. Is there a need for early palliative care in patients with life-limiting illnesses? Interview study with patients about experienced care needs from diagnosis onward. Am J Hosp Palliat Care 2015;
• 19 World Health Organization. Strengthening of palliative care as a component of integrated treatment throughout the life course. J Pain Palliat Care Pharmacother 2014; 28 (2) 130-134
• 20 Quill TE, Abernethy AP. Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 2013; 368 (13) 1173-1175
• 21 Truog RD, Campbell ML, Curtis JR , et al; American Academy of Critical Care Medicine. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med 2008; 36 (3) 953-963
• 22 Lanken PN, Terry PB, Delisser HM , et al; ATS End-of-Life Care Task Force. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008; 177 (8) 912-927
• 23 Clarke EB, Curtis JR, Luce JM , et al; Robert Wood Johnson Foundation Critical Care End-Of-Life Peer Workgroup Members. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med 2003; 31 (9) 2255-2262
• 24 Pronovost PJ, Miller MR, Dorman T, Berenholtz SM, Rubin H. Developing and implementing measures of quality of care in the intensive care unit. Curr Opin Crit Care 2001; 7 (4) 297-303
• 25 Aslakson RA, Bridges JF. Assessing the impact of palliative care in the intensive care unit through the lens of patient-centered outcomes research. Curr Opin Crit Care 2013; 19 (5) 504-510
• 26 Casarett D, Pickard A, Bailey FA , et al. Do palliative consultations improve patient outcomes?. J Am Geriatr Soc 2008; 56 (4) 593-599
• 27 Temel JS, Greer JA, Muzikansky A , et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363 (8) 733-742
• 28 Ciemins EL, Blum L, Nunley M, Lasher A, Newman JM. The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach. J Palliat Med 2007; 10 (6) 1347-1355
• 29 Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007; 35 (6) 1530-1535
• 30 O'Mahony S, McHenry J, Blank AE , et al. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med 2010; 24 (2) 154-165
• 31 Starks H, Wang S, Farber S, Owens DA, Curtis JR. Cost savings vary by length of stay for inpatients receiving palliative care consultation services. J Palliat Med 2013; 16 (10) 1215-1220
• 32 Wu FM, Newman JM, Lasher A, Brody AA. Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. J Palliat Med 2013; 16 (11) 1362-1367
• 33 Campbell ML, Guzman JA. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 2003; 123 (1) 266-271
• 34 Hua M, Wunsch H. Integrating palliative care in the ICU. Curr Opin Crit Care 2014; 20 (6) 673-680
• 35 Curtis JR, Nielsen EL, Treece PD , et al. Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med 2011; 183 (3) 348-355
• 36 Puntillo K, Arai SR, Cooper BA, Stotts NA, Nelson JE. A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients. Intensive Care Med 2014; 40 (9) 1295-1302
• 37 Nelson JE. Identifying and overcoming the barriers to high-quality palliative care in the intensive care unit. Crit Care Med 2006; 34 (11, Suppl): S324-S331
• 38 Nelson JE, Bassett R, Boss RD , et al; Improve Palliative Care in the Intensive Care Unit Project. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med 2010; 38 (9) 1765-1772
• 39 Curtis JR, Engelberg RA, Bensink ME, Ramsey SD. End-of-life care in the intensive care unit: can we simultaneously increase quality and reduce costs?. Am J Respir Crit Care Med 2012; 186 (7) 587-592
• 40 Curtis JR, Engelberg RA, Wenrich MD, Shannon SE, Treece PD, Rubenfeld GD. Missed opportunities during family conferences about end-of-life care in the intensive care unit. Am J Respir Crit Care Med 2005; 171 (8) 844-849
• 41 Lautrette A, Darmon M, Megarbane B , et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007; 356 (5) 469-478
• 42 Nelson JE, Cortez TB, Curtis JR , et al; The IPAL-ICU Project™. Integrating palliative care in the ICU: the nurse in a leading role. J Hosp Palliat Nurs 2011; 13 (2) 89-94
• 43 Kompanje EJ, van der Hoven B, Bakker J. Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life. Intensive Care Med 2008; 34 (9) 1593-1599
• 44 Nelson JE, Curtis JR, Mulkerin C , et al; Improving Palliative Care in the ICU (IPAL-ICU) Project Advisory Board. Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board. Crit Care Med 2013; 41 (10) 2318-2327
• 45 Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR. Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med 2015; 43 (5) 1102-1111
• 46 Goldsmith B, Dietrich J, Du Q, Morrison RS. Variability in access to hospital palliative care in the United States. J Palliat Med 2008; 11 (8) 1094-1102
• 47 Morrison RS. Health care system factors affecting end-of-life care. J Palliat Med 2005; 8 (Suppl. 01) S79-S87
• 48 Morrison RS, Augustin R, Souvanna P, Meier DE ; Center to Advance Palliative Care. America's care of serious illness: a state-by-state report card on access to palliative care in our nation's hospitals. J Palliat Med 2011; 14 (10) 1094-1096
• 49 Kapo J, Siegel MD. Penguins and palliative care: facilitating cultural change in the ICU. Crit Care Med 2013; 41 (10) 2443-2444
• 50 Rodriguez KL, Barnato AE, Arnold RM. Perceptions and utilization of palliative care services in acute care hospitals. J Palliat Med 2007; 10 (1) 99-110
• 51 Kross EK, Engelberg RA, Downey L , et al. Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians. Chest 2014; 145 (2) 313-321
• 52 Bradley C, Weaver J, Brasel K. Addressing access to palliative care services in the surgical intensive care unit. Surgery 2010; 147 (6) 871-877
• 53 Campbell ML, Guzman JA. A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Crit Care Med 2004; 32 (9) 1839-1843
• 54 Cheung W, Aggarwal G, Fugaccia E , et al. Palliative care teams in the intensive care unit: a randomised, controlled, feasibility study. Crit Care Resusc 2010; 12 (1) 28-35
• 55 Sihra L, Harris M, O'Reardon C. Using the improving palliative care in the intensive care unit (IPAL-ICU) project to promote palliative care consultation. J Pain Symptom Manage 2011; 42 (5) 672-675
• 56 Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med 2011; 14 (1) 17-23
• 57 Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med 2014; 189 (4) 428-436
• 58 Feldman DB, Periyakoil VS. Posttraumatic stress disorder at the end of life. J Palliat Med 2006; 9 (1) 213-218
• 59 Feldman DB. Posttraumatic stress disorder at the end of life: extant research and proposed psychosocial treatment approach. Palliat Support Care 2011; 9 (4) 407-418
• 60 Puntillo K, Nelson JE, Weissman D , et al; Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project. Palliative care in the ICU: relief of pain, dyspnea, and thirst—a report from the IPAL-ICU Advisory Board. Intensive Care Med 2014; 40 (2) 235-248
• 61 Campbell ML. Dyspnea prevalence, trajectories, and measurement in critical care and at life's end. Curr Opin Support Palliat Care 2012; 6 (2) 168-171
• 62 Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1991; 7 (2) 6-9
• 63 Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS. The symptom burden of chronic critical illness. Crit Care Med 2004; 32 (7) 1527-1534
• 64 Puntillo KA, Arai S, Cohen NH , et al. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 2010; 38 (11) 2155-2160
• 65 Radtke JV, Baumann BM, Garrett KL, Happ MB. Listening to the voiceless patient: case reports in assisted communication in the intensive care unit. J Palliat Med 2011; 14 (6) 791-795
• 66 Gélinas C, Fortier M, Viens C, Fillion L, Puntillo K. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care 2004; 13 (2) 126-135
• 67 Payen JF, Bru O, Bosson JL , et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29 (12) 2258-2263
• 68 Puntillo K, Pasero C, Li D , et al. Evaluation of pain in ICU patients. Chest 2009; 135 (4) 1069-1074
• 69 Gélinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. Am J Crit Care 2006; 15 (4) 420-427
• 70 Puntillo KA, Morris AB, Thompson CL, Stanik-Hutt J, White CA, Wild LR. Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med 2004; 32 (2) 421-427
• 71 Campbell ML. Psychometric testing of a respiratory distress observation scale. J Palliat Med 2008; 11 (1) 44-50
• 72 Campbell ML, Templin T, Walch J. A Respiratory Distress Observation Scale for patients unable to self-report dyspnea. J Palliat Med 2010; 13 (3) 285-290
• 73 Puntillo KA, Neuhaus J, Arai S , et al. Challenge of assessing symptoms in seriously ill intensive care unit patients: can proxy reporters help?. Crit Care Med 2012; 40 (10) 2760-2767
• 74 Bradt J, Dileo C. Music therapy for end-of-life care. Cochrane Database Syst Rev 2010; (1) CD007169
• 75 Bradt J, Dileo C, Grocke D. Music interventions for mechanically ventilated patients. Cochrane Database Syst Rev 2010; 12 (12) CD006902
• 76 Barach AL. Chronic obstructive lung disease: postural relief of dyspnea. Arch Phys Med Rehabil 1974; 55 (11) 494-504
• 77 Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis 1987; 136 (1) 58-61
• 78 Sharp JT, Drutz WS, Moisan T, Foster J, Machnach W. Postural relief of dyspnea in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1980; 122 (2) 201-211
• 79 Abernethy AP, McDonald CF, Frith PA , et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet 2010; 376 (9743) 784-793
• 80 Campbell ML, Yarandi H, Dove-Medows E. Oxygen is nonbeneficial for most patients who are near death. J Pain Symptom Manage 2013; 45 (3) 517-523
• 81 Halpern SD, Hansen-Flaschen J. Terminal withdrawal of life-sustaining supplemental oxygen. JAMA 2006; 296 (11) 1397-1400
• 82 Mahler DA, Selecky PA, Harrod CG , et al. American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease. Chest 2010; 137 (3) 674-691
• 83 Azoulay E, Kouatchet A, Jaber S , et al. Noninvasive mechanical ventilation in patients having declined tracheal intubation. Intensive Care Med 2013; 39 (2) 292-301
• 84 Azoulay E, Kouatchet A, Jaber S , et al. Non-invasive ventilation for end-of-life oncology patients. Lancet Oncol 2013; 14 (6) e200-e201
• 85 Curtis JR, Cook DJ, Sinuff T , et al; Society of Critical Care Medicine Palliative Noninvasive Positive Ventilation Task Force. Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med 2007; 35 (3) 932-939
• 86 Quill CM, Quill TE. Palliative use of noninvasive ventilation: navigating murky waters. J Palliat Med 2014; 17 (6) 657-661
• 87 Currow DC, McDonald C, Oaten S , et al. Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage 2011; 42 (3) 388-399
• 88 Erstad BL, Puntillo K, Gilbert HC , et al. Pain management principles in the critically ill. Chest 2009; 135 (4) 1075-1086
• 89 Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE. A systematic review of the use of opioids in the management of dyspnoea. Thorax 2002; 57 (11) 939-944
• 90 Memis D, Inal MT, Kavalci G, Sezer A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. J Crit Care 2010; 25 (3) 458-462
• 91 Pettersson PH, Jakobsson J, Owall A. Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2005; 19 (3) 306-309
• 92 Campbell-Fleming JM, Williams A. The use of ketamine as adjuvant therapy to control severe pain. Clin J Oncol Nurs 2008; 12 (1) 102-107
• 93 Pandey CK, Bose N, Garg G , et al. Gabapentin for the treatment of pain in Guillain-Barré syndrome: a double-blinded, placebo-controlled, crossover study. Anesth Analg 2002; 95 (6) 1719-1723 , table of contents
• 94 Pandey CK, Raza M, Tripathi M, Navkar DV, Kumar A, Singh UK. The comparative evaluation of gabapentin and carbamazepine for pain management in Guillain-Barré syndrome patients in the intensive care unit. Anesth Analg 2005; 101 (1) 220-225 , table of contents
• 95 Block SD. Psychological issues in end-of-life care. J Palliat Med 2006; 9 (3) 751-772
• 96 Navigante AH, Cerchietti LC, Castro MA, Lutteral MA, Cabalar ME. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage 2006; 31 (1) 38-47
• 97 Simon ST, Higginson IJ, Booth S, Harding R, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 2010; (1) CD007354
• 98 Sironi O, Sbanotto A, Banfi MG, Beltrami C. Midazolam as adjunct therapy to morphine to relieve dyspnea?. J Pain Symptom Manage 2007; 33 (3) 233-234 , author reply 234–236
• 99 Banzett RB, Adams L, O'Donnell CR, Gilman SA, Lansing RW, Schwartzstein RM. Using laboratory models to test treatment: morphine reduces dyspnea and hypercapnic ventilatory response. Am J Respir Crit Care Med 2011; 184 (8) 920-927
• 100 Pasero C, Puntillo K, Li D , et al. Structured approaches to pain management in the ICU. Chest 2009; 135 (6) 1665-1672
• 101 Beller EM, van Driel ML, McGregor L, Truong S, Mitchell G. Palliative pharmacological sedation for terminally ill adults. Cochrane Database Syst Rev 2015; 1: CD010206
• 102 Cherny NI, Radbruch L ; Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med 2009; 23 (7) 581-593
• 103 Chan JD, Treece PD, Engelberg RA , et al. Narcotic and benzodiazepine use after withdrawal of life support: association with time to death?. Chest 2004; 126 (1) 286-293
• 104 Wilson WC, Smedira NG, Fink C, McDowell JA, Luce JM. Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients. JAMA 1992; 267 (7) 949-953
• 105 Claessens P, Menten J, Schotsmans P, Broeckaert B. Palliative sedation: a review of the research literature. J Pain Symptom Manage 2008; 36 (3) 310-333
• 106 Claessens P, Menten J, Schotsmans P, Broeckaert B ; Palsed Consortium. Palliative sedation, not slow euthanasia: a prospective, longitudinal study of sedation in Flemish palliative care units. J Pain Symptom Manage 2011; 41 (1) 14-24
• 107 Claessens P, Menten J, Schotsmans P, Broeckaert B. Level of consciousness in dying patients. The role of palliative sedation: a longitudinal prospective study. Am J Hosp Palliat Care 2012; 29 (3) 195-200
• 108 Broeckaert B. Palliative sedation, physician-assisted suicide, and euthanasia: “same, same but different”?. Am J Bioeth 2011; 11 (6) 62-64
• 109 Searight HR, Gafford J. Cultural diversity at the end of life: issues and guidelines for family physicians. Am Fam Physician 2005; 71 (3) 515-522
• 110 Scheunemann LP, Arnold RM, White DB. The facilitated values history: helping surrogates make authentic decisions for incapacitated patients with advanced illness. Am J Respir Crit Care Med 2012; 186 (6) 480-486
• 111 Uy J, White DB, Mohan D, Arnold RM, Barnato AE. Physicians' decision-making roles for an acutely unstable critically and terminally ill patient. Crit Care Med 2013; 41 (6) 1511-1517
• 112 Hallenbeck JL. What's the story—how patients make medical decisions. Am J Med 2002; 113 (1) 73-74
• 113 Pickett M. Cultural awareness in the context of terminal illness. Cancer Nurs 1993; 16 (2) 102-106
• 114 Gries CJ, Curtis JR, Wall RJ, Engelberg RA. Family member satisfaction with end-of-life decision making in the ICU. Chest 2008; 133 (3) 704-712
• 115 Scheunemann LP, Cunningham TV, Arnold RM, Buddadhumaruk P, White DB. How clinicians discuss critically ill patients' preferences and values with surrogates: an empirical analysis. Crit Care Med 2015; 43 (4) 757-764
• 116 Gay EB, Pronovost PJ, Bassett RD, Nelson JE. The intensive care unit family meeting: making it happen. J Crit Care 2009; 24 (4) 629.e1-629.e12
• 117 Curtis JR, Wenrich MD, Carline JD, Shannon SE, Ambrozy DM, Ramsey PG. Patients' perspectives on physician skill in end-of-life care: differences between patients with COPD, cancer, and AIDS. Chest 2002; 122 (1) 356-362
• 118 Curtis JR, Tonelli MR. Shared decision-making in the ICU: value, challenges, and limitations. Am J Respir Crit Care Med 2011; 183 (7) 840-841
• 119 Epner DE, Baile WF. Difficult conversations: teaching medical oncology trainees communication skills one hour at a time. Acad Med 2014; 89 (4) 578-584
• 120 Nelson JE, Walker AS, Luhrs CA, Cortez TB, Pronovost PJ. Family meetings made simpler: a toolkit for the intensive care unit. J Crit Care 2009; 24 (4) 626.e7-626.e14
• 121 Penrod JD, Luhrs CA, Livote EE, Cortez TB, Kwak J. Implementation and evaluation of a network-based pilot program to improve palliative care in the intensive care unit. J Pain Symptom Manage 2011; 42 (5) 668-671
• 122 Downar J, Barua R, Sinuff T. The desirability of an Intensive Care Unit (ICU) clinician-led bereavement screening and support program for family members of ICU Decedents (ICU Bereave). J Crit Care 2014; 29 (2) 311.e9-311.e16
• 123 Lorin S, Rho L, Wisnivesky JP, Nierman DM. Improving medical student intensive care unit communication skills: a novel educational initiative using standardized family members. Crit Care Med 2006; 34 (9) 2386-2391
• 124 Yuen JK, Mehta SS, Roberts JE, Cooke JT, Reid MC. A brief educational intervention to teach residents shared decision making in the intensive care unit. J Palliat Med 2013; 16 (5) 531-536
• 125 Azoulay E, Chevret S, Leleu G , et al. Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000; 28 (8) 3044-3049
• 126 McDonagh JR, Elliott TB, Engelberg RA , et al. Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Crit Care Med 2004; 32 (7) 1484-1488
• 127 Curtis JR, White DB. Practical guidance for evidence-based ICU family conferences. Chest 2008; 134 (4) 835-843
• 128 Carson SS, Vu M, Danis M , et al. Development and validation of a printed information brochure for families of chronically critically ill patients. Crit Care Med 2012; 40 (1) 73-78
• 129 Azoulay E, Pochard F, Kentish-Barnes N , et al; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171 (9) 987-994
• 130 Stapleton RD, Engelberg RA, Wenrich MD, Goss CH, Curtis JR. Clinician statements and family satisfaction with family conferences in the intensive care unit. Crit Care Med 2006; 34 (6) 1679-1685
• 131 Treece PD, Engelberg RA, Crowley L , et al. Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med 2004; 32 (5) 1141-1148
• 132 Robinson MR, Thiel MM, Backus MM, Meyer EC. Matters of spirituality at the end of life in the pediatric intensive care unit. Pediatrics 2006; 118 (3) e719-e729
• 133 Johnson JR, Engelberg RA, Nielsen EL , et al. The association of spiritual care providers' activities with family members' satisfaction with care after a death in the ICU*. Crit Care Med 2014; 42 (9) 1991-2000
• 134 Puchalski C. Spirituality in health: the role of spirituality in critical care. Crit Care Clin 2004; 20 (3) 487-504 , x
• 135 DeCato TW, Engelberg RA, Downey L , et al. Hospital variation and temporal trends in palliative and end-of-life care in the ICU. Crit Care Med 2013; 41 (6) 1405-1411
• 136 Long AC, Kross EK, Engelberg RA , et al. Quality of dying in the ICU: is it worse for patients admitted from the hospital ward compared to those admitted from the emergency department?. Intensive Care Med 2014; 40 (11) 1688-1697
• 137 Aslakson RA, Curtis JR, Nelson JE. The changing role of palliative care in the ICU. Crit Care Med 2014; 42 (11) 2418-2428
• 138 Nelson JE, Hope AA. Integration of palliative care in chronic critical illness management. Respir Care 2012; 57 (6) 1004-1012 , discussion 1012–1013
• 139 Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med 2010; 182 (4) 446-454
• 140 Nelson JE, Tandon N, Mercado AF, Camhi SL, Ely EW, Morrison RS. Brain dysfunction: another burden for the chronically critically ill. Arch Intern Med 2006; 166 (18) 1993-1999
• 141 Jubran A, Lawm G, Duffner LA , et al. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36 (12) 2030-2037
• 142 Jubran A, Lawm G, Kelly J , et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36 (5) 828-835
• 143 Carson SS, Kahn JM, Hough CL , et al; ProVent Investigators. A multicenter mortality prediction model for patients receiving prolonged mechanical ventilation. Crit Care Med 2012; 40 (4) 1171-1176
• 144 Choi J, Donahoe MP, Zullo TG, Hoffman LA. Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience. Am J Crit Care 2011; 20 (1) 12-22 , quiz 23
• 145 Swoboda SM, Lipsett PA. Impact of a prolonged surgical critical illness on patients' families. Am J Crit Care 2002; 11 (5) 459-466
• 146 Van Pelt DC, Milbrandt EB, Qin L , et al. Informal caregiver burden among survivors of prolonged mechanical ventilation. Am J Respir Crit Care Med 2007; 175 (2) 167-173
• 147 Deacon KS. Re-building life after ICU: a qualitative study of the patients' perspective. Intensive Crit Care Nurs 2012; 28 (2) 114-122
• 148 Henrich NJ, Dodek P, Heyland D , et al. Qualitative analysis of an intensive care unit family satisfaction survey. Crit Care Med 2011; 39 (5) 1000-1005
• 149 Prinjha S, Field K, Rowan K. What patients think about ICU follow-up services: a qualitative study. Crit Care 2009; 13 (2) R46
• 150 Chaboyer W, Kendall E, Kendall M, Foster M. Transfer out of intensive care: a qualitative exploration of patient and family perceptions. Aust Crit Care 2005; 18 (4) 138-141 , 143–145
• 151 Coyle MA. Transfer anxiety: preparing to leave intensive care. Intensive Crit Care Nurs 2001; 17 (3) 138-143
• 152 McKinney AA, Deeny P. Leaving the intensive care unit: a phenomenological study of the patients' experience. Intensive Crit Care Nurs 2002; 18 (6) 320-331
• 153 Odell M. The patient's thoughts and feelings about their transfer from intensive care to the general ward. J Adv Nurs 2000; 31 (2) 322-329
• 154 Digwood G, Lustbader D, Pekmezaris R , et al. The impact of a palliative care unit on mortality rate and length of stay for medical intensive care unit patients. Palliat Support Care 2011; 9 (4) 387-392
• 155 Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med 2012; 40 (2) 618-624
• 156 Davydow DS, Hough CL, Langa KM, Iwashyna TJ. Depressive symptoms in spouses of older patients with severe sepsis. Crit Care Med 2012; 40 (8) 2335-2341
• 157 van der Klink MA, Heijboer L, Hofhuis JG , et al. Survey into bereavement of family members of patients who died in the intensive care unit. Intensive Crit Care Nurs 2010; 26 (4) 215-225
• 158 van der Schaaf M, Beelen A, Nollet F, Dongelmans DA. Postintensive care syndrome, need for recognition, treatment, research, and expansion of included symptoms. Crit Care Med 2012; 40 (9) 2742-2743 , author reply 2743
• 159 Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care 2007; 13 (5) 482-488
• 160 Embriaco N, Azoulay E, Barrau K , et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med 2007; 175 (7) 686-692
• 161 Poncet MC, Toullic P, Papazian L , et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 2007; 175 (7) 698-704
• 162 Hough CL, Hudson LD, Salud A, Lahey T, Curtis JR. Death rounds: end-of-life discussions among medical residents in the intensive care unit. J Crit Care 2005; 20 (1) 20-25
• 163 Marrone K, Lin S, Akgün KM. The association between resident reflection rounds and resident emotional distress. American Thoracic Society International Conference; 2015