Acute and Critical Care

Review Article

Basic science and research
Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review: Christantie Effendy, Yodang Yodang, Sarah Amalia, Erna Rochmawati; Acute Crit Care. 2022;37(4):516-526. Published online October 18, 2022; DOI: https://doi.org/10.4266/acc.2022.00745

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The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

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A necessidade dos cuidados paliativos na Unidade de Terapia Intensiva (UTI)
Larissa Kênia de Oliveira Barros Dos Santos, Isabella Rodrigues Ribeiro, João Pedro Manduca Ferreira, Victor Hugo Oliveira Moraes, Érika Aguiar Lara Pereira
Cuadernos de Educación y Desarrollo.2024;[Epub] CrossRef
End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
Andrea Cortegiani, Mariachiara Ippolito, Sebastiano Mercadante
Anesthesiology Clinics.2024; 42(3): 407. CrossRef
What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review
Nabat Almalki, Breidge Boyle, Peter O’Halloran
BMC Palliative Care.2024;[Epub] CrossRef
Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer
Irene Giannubilo, Linda Battistuzzi, Eva Blondeaux, Tommaso Ruelle, Francesca Benedetta Poggio, Giulia Buzzatti, Alessia D’Alonzo, Federica Della Rovere, Maria Maddalena Latocca, Chiara Molinelli, Maria Grazia Razeti, Simone Nardin, Luca Arecco, Marta Per
BMC Palliative Care.2024;[Epub] CrossRef
Palliative Care in the Intensive Care Unit: The Standard of Care
Clareen Wiencek
AACN Advanced Critical Care.2024; 35(2): 112. CrossRef
Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review
Naveen Salins, Vijay Shree Dhyani, Mebin Mathew, Ashmitha Prasad, Arathi Prahallada Rao, Anuja Damani, Krithika Rao, Shreya Nair, Vishal Shanbhag, Shwethapriya Rao, Shivakumar Iyer, Roop Gursahani, Raj Kumar Mani, Sushma Bhatnagar, Srinagesh Simha
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Barriers and Facilitators of Early Palliative Care in the Trajectory of People Living with Chronic Condition: A Mini Review Using Socio-ecological Framework to Inform Public Health Strategy
Hartiah Haroen, Sidik Maulana, Alia Harlasgunawan, Sri Rahmawati, Alvi Riansyah, Faizal Musthofa, Jerico Pardosi
Journal of Multidisciplinary Healthcare.2024; Volume 17: 4189. CrossRef
Shared Decision-making in Palliative and End‑of‑life Care in the Cardiac Intensive Care Unit
Sarah Godfrey, Alexis Barnes, Jing Gao, Jason N Katz, Sarah Chuzi
US Cardiology Review.2024;[Epub] CrossRef
Assessing IoT integration in ICUs’ settings and management: a cross-country analysis among local healthcare organizations
Anna Roberta Gagliardi, Luca Carrubbo, Shai Rozenes, Adi Fux, Daniela Siano
Digital Policy, Regulation and Governance.2024;[Epub] CrossRef
Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model
Stephanie A. Meddick‐Dyson, Jason W. Boland, Mark Pearson, Sarah Greenley, Rutendo Gambe, John R. Budding, Fliss E. M. Murtagh
Intensive Care Medicine.2024;[Epub] CrossRef
Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotlan
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Healthcare.2023; 11(17): 2438. CrossRef

Original Article

Ethics
The quality of dying and death for patients in intensive care units: a single center pilot study: Yanghwan Choi, Myoungrin Park, Da Hyun Kang, Jooseon Lee, Jae Young Moon, Heejoon Ahn; Acute Crit Care. 2019;34(3):192-201. Published online April 8, 2019; DOI: https://doi.org/10.4266/acc.2018.00374

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Abstract PDF Supplementary Material

Background
To identify the necessary care for dying patients in intensive care units (ICUs), we designed a retrospective study to evaluate the quality of dying and death (QODD) experienced by the surrogates of patients with medical illness who died in the ICU of a tertiary referral hospital.
Methods
To achieve our objective, the authors compared the QODD scores as appraised by the relatives of patients who died of cancer under hospice care with those who died in the ICU. For this study, a Korean version of the QODD questionnaire was developed, and individual interviews were also conducted.
Results
Sixteen people from the intensive care group and 23 people from the hospice care group participated in the survey and completed the questionnaire. The family members of patients who died in the ICU declined participation at a high rate (50%), with the primary reason being to avoid bringing back painful memories (14 people, 87.5%). The relatives of the intensive care group obtained an average total score on the 17-item QODD questionnaire, which was significantly lower than that of the relatives of the hospice group (48.7±15.5 vs. 60.3±14.8, P=0.03).
Conclusions
This work implies that there are unmet needs for the care of dying patients and for the QODD in tertiary hospital ICUs. This result suggests that shared decision making for advance care planning should be encouraged and that education on caring for dying patients should be provided to healthcare professionals to improve the QODD in Korean ICUs.

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Seung Hwan Kim, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Taek Min Nam
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Family Members’ Feedback on the “Quality of Death” of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis
Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Shun Yoshihara, Yuma Ota, Saiko Okamoto, Ayako Fukushima, Haruyoshi Hirashima
Cureus.2024;[Epub] CrossRef
Factors associated with the quality of dying and death and missed nursing care
Shahin Gahramani, Mokhtar Mahmoudi, Nouri, Sina Valiee
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Bereaved family members’ perspectives on quality of death in deceased acute cardiovascular disease patients compared with cancer patients – a comparison of the J-HOPE3 study and the quality of palliative care in heart disease (Q-PACH) study
Takahiro Suzuki, Mitsunori Miyashita, Takashi Kohno, Jeffrey Rewley, Naoko Igarashi, Maho Aoyama, Michiaki Higashitani, Naoto Kawamatsu, Takeshi Kitai, Tatsuhiro Shibata, Makoto Takei, Kotaro Nochioka, Gaku Nakazawa, Hiroki Shiomi, Shigeru Tateno, Toshihi
BMC Palliative Care.2024;[Epub] CrossRef
Intensive care unit interventions to improve quality of dying and death: scoping review
Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Yusuke Oyama, Yuta Tanaka, Kentaro Kaneko, Ayako Fukushima, Yuma Ota
BMJ Supportive & Palliative Care.2024; : spcare-2024-004967. CrossRef
Associations between palliative-care consultations and end-of-life quality in cancer patients’ last 6 months
Shan Ting Chen, San Chi Chen, Hsing Jung Lee, Chen Hsiu Chen
Supportive Care in Cancer.2024;[Epub] CrossRef
Quality of dying and death in intensive care units: family satisfaction
Fur-Hsing Wen, Ming Chu Chiang, Chung-Chi Huang, Tsung-Hui Hu, Wen-Chi Chou, Li-Pang Chuang, Siew Tzuh Tang
BMJ Supportive & Palliative Care.2023; 13(e3): e1217. CrossRef
Development of an End-of-Life Nursing Care Protocol for Intensive Care Units
Jungeun Kim, Hye Young Yun, Euni Ji Kim, Hyunsook Kim, Geon Ah Kim, Sung Ha Kim, Jayoung Koo, Ju Youn Park, Aisoon Park, Eugene Han, So Yeon Kim, Jihye Jeong, Sanghee Kim
Journal of Hospice & Palliative Nursing.2022; 24(4): E159. CrossRef
Nurses’ perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study
Dan-dan Xu, Dan Luo, Jie Chen, Ji-li Zeng, Xiao-lin Cheng, Jin Li, Juan-juan Pei, Fen Hu
BMC Palliative Care.2022;[Epub] CrossRef
The Quality of Dying and Death of Advanced Cancer Patients in Palliative Care and Its Association With Place of Death and Quality of Care
Daniel Gutiérrez-Sánchez, Rafael Gómez-García, María Luisa Martín Roselló, Antonio I. Cuesta-Vargas
Journal of Hospice & Palliative Nursing.2021; 23(3): 264. CrossRef
The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective
Tera Cushman, David B. Waisel, Miriam M. Treggiari
Anesthesia & Analgesia.2021;[Epub] CrossRef
Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
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International Journal of Environmental Research and Public Health.2020; 17(12): 4443. CrossRef

Review

The End-of-Life Care in the Intensive Care Unit: Jae Young Moon, Yong Sup Shin; Korean J Crit Care Med. 2013;28(3):163-172.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.163

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Abstract PDF

The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient's autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient's death in imminent. To improve understanding EOL care of terminally ill patients, we summarize 'Recommendations for EOL care in the ICU by the American College of Critical Care Medicine' and 'Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science'. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

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A Scoping Review of End-Of-Life Care Education Programs for Critical Care Nurses
Eugene HAN, Sumi CHOI, Ki Young YUN, Sung Ha KIM, Sanghee KIM, Hye Young YUN
Korean Journal of Medical Ethics.2023; 26(3): 185. CrossRef
Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards
Nan Song, Ja Yun Choi
Asian Oncology Nursing.2020; 20(1): 10. CrossRef
Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction
Kkot Bi Jeon, Mihyun Park
Journal of Korean Academy of Nursing Administration.2019; 25(1): 42. CrossRef
Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study
Hyun Sook Kim, Eun Kyoung Choi, Tae Hee Kim, Hye Young Yun, Eun Ji Kim, Jin Ju Hong, Jeong A Hong, Geon Ah Kim, R.N. Sung Ha Kim
The Korean Journal of Hospice and Palliative Care.2019; 22(2): 87. CrossRef
Factors Influencing Performance of End-of-life Care by ICU Nurses
Mun Jung Ko, So-Hyun Moon
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 327. CrossRef
Development of an Electronic Document for DNR Informed Consent based on the Electronic Medical Record System
Ji-Kyeong Park
The Korean Journal of Health Service Management.2016; 10(3): 99. CrossRef
Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
The Korean Journal of Critical Care Medicine.2015; 30(2): 73. CrossRef
Application of Animation Mobile Electronic Informed Consent in Inpatient of Long-term Care Hospital: Focused on DNR Informed Consent
Ji-Kyeong Park, Ji-On Kim
Journal of Digital Convergence.2015; 13(11): 187. CrossRef

Original Articles

Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy: Jae Young Moon, Hee Young Lee, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2012;27(1):16-23.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.16

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Abstract PDF

BACKGROUND
In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines.
METHODS
The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers.
RESULTS
75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying.
CONCLUSIONS
In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent.

Citations

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Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses
Eun Kyung Choi, Jiyeon Kang, Hye Youn Park, Yu Jung Kim, Jinui Hong, Shin Hye Yoo, Min Sun Kim, Bhumsuk Keam, Hye Yoon Park
Journal of Korean Medical Science.2023;[Epub] CrossRef
The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities
Sooyoun Han
Asian Social Work and Policy Review.2016; 10(2): 200. CrossRef
A Study of Social Workers’ Understanding of Elderly Patients’ and Family Caregivers’ Rights to End-of-Life Care Decisions and of Their Own Roles in the Process
Sooyoun Han
The Korean Journal of Hospice and Palliative Care.2015; 18(1): 42. CrossRef
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
Korean Journal of Critical Care Medicine.2014; 29(3): 160. CrossRef
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean Journal of Critical Care Medicine.2013; 28(3): 163. CrossRef

Do-not-resuscitate Order in Patients, Who Were Deceased in a Medical Intensive Care Unit of an University Hospital in Korea: Kwangha Lee, Hang Jea Jang, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2008;23(2):84-89.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.84

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63 Download
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Abstract PDF

BACKGROUND
Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient's family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006.
METHODS
The charts of patients who had died in the medical ICU were retrospectively reviewed.
RESULTS
One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 +/- 14.0 and 23.2 +/- 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%).
CONCLUSIONS
DNR orders are well-accepted by the patient's family in the ICU. However, DNR orders are initiated when patient death is imminent.

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The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
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Jae Young Moon, Yong Sup Shin
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Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
Korean Journal of Critical Care Medicine.2012; 27(1): 16. CrossRef
Current status of end-of-life care in Korean hospitals
Younsuck Koh
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