Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care∗

Jennifer A. Frontera, J. Randall Curtis, Judith E. Nelson, Margaret Campbell, Michelle Gabriel, Anne C. Mosenthal, Colleen Mulkerin, Kathleen A. Puntillo, Daniel E. Ray, Rick Bassett, Renee D. Boss, Dana R. Lustbader, Karen Brasel, Stefanie P. Weiss, David E. Weissman

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objectives: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury." Data Extraction and Synthesis: We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions: Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.

Original languageEnglish (US)
Pages (from-to)1964-1977
Number of pages14
JournalCritical Care Medicine
Volume43
Issue number9
DOIs
StatePublished - Sep 1 2015

Fingerprint

Palliative Care
Patient Care Planning
Tissue and Organ Procurement
Patient-Centered Care
Terminal Care
Quality of Health Care
Information Storage and Retrieval
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Critical Care
Practice Guidelines
PubMed
MEDLINE
Brain Injuries
Decision Making
Language
Stroke
Therapeutics

Keywords

  • end-of-life care
  • intensive care unit
  • neurocritical care
  • neurointensive care unit
  • palliative care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Integrating Palliative Care into the Care of Neurocritically Ill Patients : A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care∗. / Frontera, Jennifer A.; Curtis, J. Randall; Nelson, Judith E.; Campbell, Margaret; Gabriel, Michelle; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Bassett, Rick; Boss, Renee D.; Lustbader, Dana R.; Brasel, Karen; Weiss, Stefanie P.; Weissman, David E.

In: Critical Care Medicine, Vol. 43, No. 9, 01.09.2015, p. 1964-1977.

Research output: Contribution to journalArticle

Frontera, JA, Curtis, JR, Nelson, JE, Campbell, M, Gabriel, M, Mosenthal, AC, Mulkerin, C, Puntillo, KA, Ray, DE, Bassett, R, Boss, RD, Lustbader, DR, Brasel, K, Weiss, SP & Weissman, DE 2015, 'Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care∗', Critical Care Medicine, vol. 43, no. 9, pp. 1964-1977. https://doi.org/10.1097/CCM.0000000000001131
Frontera, Jennifer A. ; Curtis, J. Randall ; Nelson, Judith E. ; Campbell, Margaret ; Gabriel, Michelle ; Mosenthal, Anne C. ; Mulkerin, Colleen ; Puntillo, Kathleen A. ; Ray, Daniel E. ; Bassett, Rick ; Boss, Renee D. ; Lustbader, Dana R. ; Brasel, Karen ; Weiss, Stefanie P. ; Weissman, David E. / Integrating Palliative Care into the Care of Neurocritically Ill Patients : A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care∗. In: Critical Care Medicine. 2015 ; Vol. 43, No. 9. pp. 1964-1977.
@article{548aac66cdbe4a1db7574b14a26d1c30,
title = "Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care∗",
abstract = "Objectives: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term {"}palliative care,{"} {"}supportive care,{"} {"}end-of-life care,{"} {"}withdrawal of life-sustaining therapy,{"} {"}limitation of life support,{"} {"}prognosis,{"} or {"}goals of care{"} together with {"}neurocritical care,{"} {"}neurointensive care,{"} {"}neurological,{"} {"}stroke,{"} {"}subarachnoid hemorrhage,{"} {"}intracerebral hemorrhage,{"} or {"}brain injury.{"} Data Extraction and Synthesis: We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions: Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.",
keywords = "end-of-life care, intensive care unit, neurocritical care, neurointensive care unit, palliative care",
author = "Frontera, {Jennifer A.} and Curtis, {J. Randall} and Nelson, {Judith E.} and Margaret Campbell and Michelle Gabriel and Mosenthal, {Anne C.} and Colleen Mulkerin and Puntillo, {Kathleen A.} and Ray, {Daniel E.} and Rick Bassett and Boss, {Renee D.} and Lustbader, {Dana R.} and Karen Brasel and Weiss, {Stefanie P.} and Weissman, {David E.}",
year = "2015",
month = "9",
day = "1",
doi = "10.1097/CCM.0000000000001131",
language = "English (US)",
volume = "43",
pages = "1964--1977",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Integrating Palliative Care into the Care of Neurocritically Ill Patients

T2 - A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care∗

AU - Frontera, Jennifer A.

AU - Curtis, J. Randall

AU - Nelson, Judith E.

AU - Campbell, Margaret

AU - Gabriel, Michelle

AU - Mosenthal, Anne C.

AU - Mulkerin, Colleen

AU - Puntillo, Kathleen A.

AU - Ray, Daniel E.

AU - Bassett, Rick

AU - Boss, Renee D.

AU - Lustbader, Dana R.

AU - Brasel, Karen

AU - Weiss, Stefanie P.

AU - Weissman, David E.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Objectives: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury." Data Extraction and Synthesis: We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions: Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.

AB - Objectives: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. Data Sources: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury." Data Extraction and Synthesis: We reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting. Conclusions: Most neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.

KW - end-of-life care

KW - intensive care unit

KW - neurocritical care

KW - neurointensive care unit

KW - palliative care

UR - http://www.scopus.com/inward/record.url?scp=84952788808&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84952788808&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000001131

DO - 10.1097/CCM.0000000000001131

M3 - Article

C2 - 26154929

AN - SCOPUS:84952788808

VL - 43

SP - 1964

EP - 1977

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 9

ER -