Christa Schorr, DNP, MSN, RN, FCCM
Clinical Nurse Scientist
Cooper Hospital University Medical Center
Camden, NJ
Disclosure information not submitted.
Krystal Hunter, MBA
Statistician
Cooper University Health Care
Camden, New Jersey, United States
Disclosure information not submitted.
Youssef Elfatatry, BS
Student Physician
Cooper Medical School at Rowan University, United States
Disclosure information not submitted.
Title: Timing of End of Life Discussions in the ICU
INTRODUCTION/HYPOTHESIS: End of Life (EOL), palliative, and hospice services are increasingly being utilized in the ICU. It is unclear how the role of patient/family preferences, demographics, and patient acuity contribute to the timing of EOL discussions. The objective of this study was to evaluate if there is a relationship between patient and family demographics with the timing of EOL discussions.
Methods: A retrospective study of patients admitted to an ICU and expired or were discharged to hospice from the ICU between January 2019 to June 2019. Data included patient demographics, preferred language, relationship of primary decision maker, discharge disposition and goals of care discussion. The number of days elapsed between the first EOL conversation and date of expiration/discharge was compared between patients of varying demographic and EOL preferences. Analysis was completed using Mann-Whitney U and Kruskall-Wallis tests as appropriate.
Results: A total of 180 patients met criteria of which 46% received a palliative care consult. Patients with a palliative care consult in the ICU had earlier EOL discussions from the time of expiration/discharge (2 days vs. 1 day [P=0.045]). There was no difference in the timing of EOL discussions based on sex, age, race, ethnicity, preferred language, identity of primary decision maker, discharge location, or if they had a documented goals of care discussion prior to ICU admission.
Conclusions: Presence of a palliative care consult was associated with earlier EOL discussions. Timing of EOL discussions did not vary across patient demographics. Less than half of the patients received a palliative care consult which may be due to limited or delayed resources. Applying the principles of palliative care in the absence of a consult is an approach that ICU clinicians may consider to improve the quality of life of patients and families facing life-threatening illnesses.