Philip Dela Cruz, n/a
Resident Physician
UHS SoCal MEC Internal Medicine Residency, United States
Disclosure information not submitted.
Obinna Ome Irondi
George Washington University School of Medicine & Health Sciences
Arlington
Disclosure information not submitted.
Erica Schockett, MD
Assistant Professor
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Danielle Davison, MD
Associate Professor of Anesthesiology and Critical Care Medicine and of Medicine
George Washington University Medical Center, United States
Disclosure information not submitted.
David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Erin Jackson, MD
Assistant professor
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Title: Addressing Palliative Domains for the Mechanically Ventilated: Do We Talk More if Patients Cannot?
Introduction: 20-40% of ICU admissions require mechanical ventilation in the US. Indications for mechanical ventilation, often represent more serious illness, requiring a more comprehensive discussion during patient rounds. Palliative medicine focuses on improving communication, quality of life, and symptom support. Palliative care discussions in the ICU may be beneficial in providing a quality patient-centered approach to critically-ill patients. The objective of this study was to determine if there was a difference in the frequency of discussion of palliative domains during ICU teaching rounds in the care of mechanically ventilated (MV) patients vs non-MV patients.
Methods: We conducted a single-blinded study at a single urban academic medical center ICU. Observations occurred from Jan 1 - Jun 1, 2021. ICU rounds were secretly observed for explicit verbalization of palliative domains: surrogate decision-maker(s), advance directives, goals of care, conversations with family, plan for family meeting, pain levels, and pain management. Patients were divided into MV and non-MV groups. The MV group was composed of patients ventilated with endotracheal tubes or trach collars.
Results: 191 assessments were performed for MV patients, 242 for non-MV patients. Most palliative domains were verbalized more frequently during rounds on MV patients: Surrogate decision-maker(s) (27.2% vs 9.1%, p< 0.01); Advance Directive (11.5% vs 6.2%, p=0.05); Goals of Care (16.8% vs 7.0% p< 0.01); Conversations with Family (42.9% vs 21.6%, p< 0.01); Plan for Family Meeting (23.6% vs 7.9%, p< 0.01); Pain Management Plan (65.4% vs 54.5% p=0.02). Pain levels was the single domain verbalized less frequently during rounds on MV patients (24.1% vs 32.6% p=0.05).
Conclusion: The data suggests that physicians more frequently discuss palliative care domains during ICU teaching rounds for patients who are mechanically ventilated. This may be due to the perceived greater needs of care in the MV vs the non-MV. The results also show that physicians discuss pain levels less frequently in MV patients. This suggests an opportunity to improve discussions around pain in the MV patient. Future studies can may look at the implementation of a best practices model that includes a systematic discussion of palliative domains in both the MV and non-MV.