Palliative care terminology and practice in intensive care units in the Czech Republic: results of PEOpLE‑C19 study
Authors:
T. Prokopová 1,2; J. Hudec 1,2; K. Vrbica 1; J. Stašek 1; A. Pokorná 3,4,5; P. Štourač 2,6; K. Rusinová 7; P. Kerpnerová 8; R. Štěpánová 9; A. Svobodník 9; J. Maláska 2,6,10; Ripe-Icu Skupina Výzkumná
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity, Brno
1; Ústav simulační medicíny, Lékařská fakulta Masarykovy univerzity, Brno
2; Ústav zdravotnických věd, Lékařská fakulta Masarykovy univerzity, Brno
3; Institut biostatistiky a analýz, Lékařská fakulta Masarykovy univerzity, Brno
4; České národní centrum Evidence-based Healthcare Translation, Lékařská fakulta Masarykovy univerzity, Brno
5; Klinika dětské anesteziologie a resuscitace, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity, Brno
6; Klinika paliativní medicíny, 1. lékařská fakulta Karlovy univerzity a Všeobecná fakultní nemocnice v Praze, Praha
7; ANOVA CRO, s. r. o., Praha
8; Farmakologický ústav, Lékařská fakulta Masarykovy Univerzity, Brno
9; II. anesteziologicko‑resuscitační, oddělení, Fakultní nemocnice Brno
10
Published in:
Anest. intenziv. Med., 33, 2022, č. 5, s. 198-204
Category:
Original Papers
doi:
https://doi.org/10.36290/aim.2022.032
Overview
Study goal: Palliative care is an essential part of a complex approach to patients in the intensive care unit (ICU). This study aimed to describe palliative care practice in ICU in the Czech Republic.
Study type: a cross-sectional, questionnaire study
Material and methods: The inclusion criteria for study participation were nurses or physicians taking care of patients in the ICU for patients with Coronavirus Disease 2019 (COVID-19). The participants could participate by filling out the electronic survey with 40 questions. The questionnaire was evaluated by descriptive statistical analysis.
Results: 313 questionnaires were analyzed. Participants reported up to 15 different terms for end-of-life care, the most often being palliative care (75.1%, n=235). The supportive care, especially sedatives, was most frequently adjusted according to the patient’s needs. On the other hand, as a standard approach, the parenteral (35.8%, n=112) and enteral (17.3%, n=54) nutrition were most often withdrawn. Regarding organ support, renal replacement therapy (69.7%, n=218) and vasopressors (60.4%,
n=189) were often withdrawn. The most rarely withdrawn organ support was artificial ventilation (24.6%, n=77), endotracheal intubation (11.5%,n=36), and tracheostomy cannula (2.9%, n=9). The majority of respondents would appreciate further education in palliative care.
Conclusion: Palliative care is an essential theme not only in the COVID-19 pandemic. The palliative care terminology and practice used in the Czech Republic are heterogeneous. There is a space for further research and education in palliative care.
Keywords:
palliative care – intensive care unit – terminology – end-of-life care
Sources
1. Radbruch L, de Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining Palliative Care – A New Consensus‑Based Definition. Journal of Pain and Symptom Management. 2020;60(4):754-64.
2. Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. Journal of Palliative Medicine. 2018;21(12):1684-9.
3. Fernando GVMC, Hughes S. Team approaches in palliative care: A review of the literature. International Journal of Palliative Nursing. 2019 Sep 2;25(9):444-51.
4. Angus DC, Truog RD. Toward better ICU use at the end of life. JAMA. 2016;315(3): 255-6.
5. Konsenzuální stanovisko k poskytování paliativní péče u nemocných s nezvratným orgánovým selháním (ČSARIM ČLS JEP, ČSIM ČLS JEP) | proLékaře.cz. Available from: https://www.prolekare.cz/casopisy/anesteziologie‑intenzivni‑medicina/ 2009-4/ konsenzualni‑stanovisko‑k- poskytovani‑paliativni‑pece‑u- nemocnych‑s- nezvratnym‑organovym‑selhanim‑csarim‑cls‑jep‑csim‑cls‑jep- 7692.
6. Vincent JL, Marshall JC, Ñamendys‑Silva SA, François B, Martin‑ Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: The Intensive Care Over Nations (ICON) audit. The Lancet Respiratory Medicine. 2014;2(5):380-6.
7. Teno JM, Gozalo PL, Bynum JPW, Leland NE, Miller SC, Morden NE, et al. Change in end‑of‑ life care for medicare beneficiaries: Site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470-7.
8. Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end‑of‑ life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Critical Care Medicine. 2008;36(3):953-63.
9. Hua M, Wunsch H. Integrating palliative care in the ICU. Curr Opin Crit Care. 2014;20(6):673-80. Available from: https://pubmed.ncbi.nlm.nih.gov/25233330/
10. Myburgh J, Abillama F, Chiumello D, Dobb G, Jacobe S, Kleinpell R, et al. End‑of‑life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care. 2016;34: 125-30.
11. Flannery L, Ramjan LM, Peters K. End‑of‑ life decisions in the Intensive Care Unit (ICU) - Exploring the experiences of ICU nurses and doctors - A critical literature review. Australian Critical Care. 2016;29(2):97-103.
12. Benoit DD, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, et al. Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA. Intensive Care Med. 2018;44(7):1039-49. Available from: https://pubmed.ncbi.nlm.nih.gov/29808345.
13. Garten L, Danke A, Reindl T, Prass A, Bührer C. End‑of‑ Life Care Related Distress in the PICU and NICU: A Cross‑Sectional Survey in a German Tertiary Center. Frontiers in Pediatrics. 2021;9.
14. Prokopová T, Hudec J, Vrbica K, Stašek J, Pokorná A, Štourač P, et al. Palliative care practice and moral distress during COVID-19 pandemic (PEOpLE‑C19 study): a national, cross‑ sectional study in intensive care units in the Czech Republic. Crit Care. 2022;26(1):221. Available from: https://pubmed.ncbi.nlm.nih.gov/35854318/
15. Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, et al. A Consensus‑ Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021;36(10):3179-87. Available from: https://pubmed.ncbi.nlm.nih. gov/33886027/.
16. Jones J, Hunter D. Qualitative Research: Consensus methods for medical and health services research. BMJ. 1995;311(7001):376.
17. Burns KEA, Duffett M, Kho ME, Meade MO, Adhikari NKJ, Sinuff T, et al. A guide for the design and conduct of self‑administered surveys of clinicians. CMAJ. 2008;179(3):245-52.
18. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E‑Surveys (CHERRIES). J Med Internet Res [Internet]. 2004 [cited 2022 Mar 30];6(3). Available from: https://pubmed.ncbi.nlm.nih.gov/15471760.
19. Salins N, Gursahani R, Mathur R, Iyer S, MacAden S, Simha N, et al. Definition of Terms Used in Limitation of Treatment and Providing Palliative Care at the End of Life: The Indian Council of Medical Research Commission Report. Indian Journal of Critical Care Medicine : Peer‑ reviewed, Official Publication of Indian Society of Critical Care Medicine. 2018;22(4):249. Available from: /pmc/articles/PMC5930529.
20. Hui D, de La Cruz M, Mori M, Parsons HA, Kwon JH, Torres‑Vigil I, et al. Concepts and definitions for „supportive care,“ „best supportive care,“ „palliative care,“ and „hospice care“ in the published literature, dictionaries, and textbooks. Supportive Care in Cancer. 2013 Mar;21(3):659-85.
21. Weil J, Weiland TJ, Lane H, Jelinek GA, Boughey M, Marck CH, et al. What’s in a name? A qualitative exploration of what is understood by „palliative care“ in the emergency department. Palliative Medicine. 2015;29(4):293-301.
22. Vincent JL. Withdrawing may be preferable to withholding. Crit Care. 2005;9(3):226-9. Available from: https://pubmed.ncbi.nlm.nih.gov/15987405.
23. Coelho CBT, Yankaskas JR. New concepts in palliative care in the intensive care unit. Rev Bras Ter Intensiva. 2017;29(2):222-30. Available from: https://pubmed.ncbi.nlm.nih.gov/28977262.
24. Thellier D, Delannoy PY, Robineau O, Meybeck A, Boussekey N, Chiche A, et al. Comparison of terminal extubation and terminal weaning as mechanical ventilation withdrawal in ICU patients. Minerva Anestesiologica. 2017;83(4):375-82.
25. O’Mahony S, McHugh M, Zallman L, Selwyn P. Ventilator withdrawal: procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service. J Pain Symptom Manage. 2003 Oct 1;26(4):954-61. Available from: https://pubmed.ncbi.nlm.nih.gov/14575056.
26. Downar J, Delaney JW, Hawryluck L, Kenny L. Guidelines for the withdrawal of life‑sustaining measures. Intensive Care Med. 2016;42(6):1003-17. Available from: https:// pubmed.ncbi.nlm.nih.gov/27059793.
27. Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: Why, where, what, who, when, how. BMC Anesthesiology. 2018;18(1).
28. Robert R, le Gouge A, Kentish‑Barnes N, Cottereau A, Giraudeau B, Adda M, et al. Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study). Intensive Care Medicine. 2017;43(12):1793-807.
29. Newman AJ, Kvale EA, Williams BR, Bailey FA. What about the trach? Tracheotomy removal as a palliative care maneuver. Am J Hosp Palliat Care. 2007;24(5):371-5. Available from: https://pubmed.ncbi.nlm.nih.gov/17601830.
30. Merel SE, Spiker M, Stack SW, Paauw DS. „tell Me More“: Students Can Practice and Self‑ Evaluate Primary Palliative Care Skills in a Large, Multistate Internal Medicine Clerkship. Journal of Palliative Medicine. 2021;24(2):261-6.
31. Frydman JL, Hauck K, Lowy J, Gelfman LP. Improving the Care of Patients With Serious Illness: What Are the Palliative Care Education Needs of Internal Medicine Residents? American Journal of Hospice and Palliative Medicine. 2021;38(10):1218-24.
32. Bonanno AM, Kiraly LN, Siegel TR, Brasel KJ, Cook MR. Surgical palliative care training in general surgery residency: An educational needs assessment. American Journal of Surgery. 2019;217(5):928-31.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2022 Issue 5
Most read in this issue
- Suxamethonium – is it still needed?
- Vliv umělé plicní ventilace na orgánové funkce
- PR illiteracy of anaesthesiologists?
- Impact factor – how to distinguish the proper one?