Palliative care in the intensive care unit

Prof David Oliver and Dr Elena Stanton explain the background to a longer article in the May/June issue of the European Journal of Palliative Care

Prof David Oliver

In 1991 a Hospital Palliative Care Team was started within the Medway Maritime Hospital in Gillingham, UK – a local hospital with 660 beds. The Team has expanded over the years and there are now four specialist nurses, with regular support from the Consultant in Palliative Medicine at the Wisdom Hospice. The team is part of the wider palliative care services in the Medway and Swale area.

The team visit nearly all wards and departments within the hospital and see more than 1,500 patients each year. In recent years there has been increasing involvement within the Intensive Care Unit (ICU). Before retirement in 2016, I (David) provided the medical support in the hospital in my final two years and became more aware of this work. I started to record the patients seen and then together with Dr Elena Stanton, a Registrar in the ITU, analysed the issues and patients seen.

Dr Elena Stanton

This study has now been published in the European Journal of Palliative Care – see link below. Over a two-year period, 24 patients were seen on the ITU – 33 per cent with cancer and 66 per cent with non-malignant disease. The issues that were raised were for advice on symptom management, ethical advice, in particular withdrawal of treatment, support for families and concerns about further care of patients, who no longer required intensive care but were deteriorating. Three patients were transferred to the Wisdom Hospice directly from the ITU – two died (four and nine days after transfer) and one man improved and was discharged home, where he died 11 months later.

Medway Maritime Hospital in Gillingham, UK

Here is one of the case histories that we discuss in our article in the EJPC:

Mrs C, an 88-year-old lady who had fallen at home, giving a history of feeling lightheaded and dizzy. After admission to hospital she deteriorated and collapsed and was transferred back to the acute hospital; a CT scan confirmed a subdural haematoma and she was admitted to ITU. Due to comorbidities and her deteriorating condition, no further treatment was planned and it was agreed after a full assessment and consultation with her family that treatment would be withdrawn.

The Hospital Palliative Care Team were asked for advice on management of her symptoms and took part in discussions with her family who realised that she may die very soon. The many family members needed support, and the ITU staff asked for continued support from the HPCT until she died two days later.

The collaboration and involvement in the ITU have developed from close working relationships over the years. The request for ethical advice shows that there is trust and a collaborative relationship between the Hospital Palliative Care Team and the ITU staff. The study has shown that palliative care is appropriate in the intensive care setting and a collaborative interaction between teams can facilitate better care and support for patients, families and staff.

Read the full article in the European Journal of Palliative Care

This post relates to a longer article, ‘Palliative care in the intensive care unit’ by David Oliver and Elena Stanton published in the May/June 2017 edition of the European Journal of Palliative Care (EJPC). (vol. 24.3).

If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journalclick here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog.  

More about the authors …

David Oliver is an honorary professor at the University of Kent, in the UK, and a Board member of the European Association for Palliative Care. Before retirement, David was Consultant in Palliative Medicine at the Wisdom Hospice, Rochester, UK.

Elena Stanton is an Anaesthetics Specialist Trainee and was working in the Intensive Care Unit of the Medway Maritime Hospital, Gillingham, UK. At present she is at Guy’s and St Thomas’ NHS Foundation Trust in London, UK.

 

 

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