4.4 Article

Palliative Care Consultations in the Neuro-ICU: A Qualitative Study

期刊

NEUROCRITICAL CARE
卷 25, 期 2, 页码 266-272

出版社

HUMANA PRESS INC
DOI: 10.1007/s12028-016-0283-5

关键词

Neurocritical care; Palliative care; Prognosis; Patient-centered; Qualitative research

资金

  1. Cambia Health Foundation (Sojourns Scholars Leadership Award)
  2. Institute of Translational Health Sciences TL1 Summer Program
  3. NCATS [TL1 TR000422]

向作者/读者索取更多资源

Integration of palliative care (PC) into the neurological intensive care unit (neuro-ICU) is increasingly recommended, but evidence regarding the best practice is lacking. We conducted a qualitative analysis exploring current practices and key themes of specialist PC consultations in patients admitted to a single neuro-ICU. We retrospectively identified all patients who were admitted to the neuro-ICU for aeyen24 h and received a PC consultation between January and August 2014. We reviewed PC consultation notes and neuro-ICU progress notes from the electronic health records of these patients. We performed content analysis on the PC notes. Twenty-five neuro-ICU patients (4 %) received a PC consultation over 8 months with the most prevalent reason of clarifying goals of care. The main distinctions between patients with and those without (n = 580) a PC consultation were ICU length of stay (median 8.2 vs. 2.8 days) and death in the neuro-ICU (56 % vs. 11 %). The most prevalent themes addressed in the PC consultation notes were (1) discussing prognosis, (2) eliciting patient and family values, (3) understanding medical options, and (4) identifying conflict. PC consultations in the neuro-ICU emphasize family coping and decision-making by helping discuss prognosis and exploring patient and family values as well as their ability to understand the medical information. Several features suggest that earlier integration of PC into neuro-ICU care may enhance both coping and the decision-making process.

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