RecruitingNot ApplicableNCT06490835

Feasibility Study on Implementing Consultation-based High-quality Palliative Care Services in Intensive Care Units

A Feasibility Study Protocol for Implementing Consultation-based Palliative Care Services to Provide High-quality Palliative Care to Families of Critically Ill Patients in Intensive Care Units: A Single-arm Pilot Study

Sponsor

Seoul National University Hospital

Enrollment

20 participants

Start Date

Jun 19, 2024

Study Type

INTERVENTIONAL

Conditions

Critical Illness

Summary

Critically ill patients in intensive care units (ICUs) receive life-sustaining treatments aimed at restoring or maintaining organ function. ICU admission often involves substantial physical and existential pressures that can burden patients, their families, and surrogates. Multidisciplinary palliative care support can help alleviate potential causes of suffering. Twenty patients admitted to the ICUs at Seoul National University Hospital, diagnosed with sudden and severe acute brain injury or progressive organ failure, along with their surrogates, will be enrolled in the study. This study aims to assess the feasibility of applying consultation-based palliative care services to provide higher quality palliative care for critically ill patients with acute illnesses and their families facing poor prognoses upon ICU admission. Additionally, the study seeks to determine whether providing such palliative care services can help better respect the patient's values and goals, reduce communication conflicts, alleviate family caregivers' anxiety and depression, and enhance satisfaction with critical care.

Eligibility

Min Age: 19 Years

Inclusion Criteria16

Patients:
Diagnosis of sudden and severe acute brain injury due to at least one of the following etiologies: vascular, traumatic, metabolic, toxic, infectious, or anoxic AND
Glasgow Coma Scale score of 3-8 for at least 24 hours after the patient's admission AND
Unable to express themselves verbally or otherwise
OR
Diagnosis of advanced stage organ failure (any of the following)
Chronic lung disease requiring long-term oxygen therapy or mechanical ventilation
Decompensated liver cirrhosis
Chronic heart failure with NYHA class III or IV
Progressive neurological disease with a modified Rankin score of 3-5 (e.g., dementia, Parkinson's disease, and amyotrophic lateral sclerosis)
Three or more chronic comorbidities causing limitations in activities of daily living (ADL) AND
APACHE II score ≥ 14 at the time of screening AND
ICU stay of 7 days or more
Surrogates:
Aged 19 or older
Willing and able to provide consent for participation in the study

Exclusion Criteria15

Patients:
Under 19 years of age
Unable to speak, understand, or read Korean
Refusal of palliative care consultation
Referred to palliative care prior to study enrollment
Within 48 hours of ICU admission
Presence of active cancer under treatment within 6 months prior to ICU admission
Care goals set to "comfort care" at the time of study enrollment
Death expected within 48 hours at the time of study enrollment
Lack of capacity to participate in the study without an appropriate surrogate
Surrogates:
Under 19 years of age
Unable to speak, understand, or read Korean
Determined by a physician to be in extremely poor health, making participation in the study infeasible
Refusal of palliative care consultation

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Interventions

BEHAVIORALHigh-quality palliative care through consultation-based palliative care services in the ICU

Family Counseling: Social workers implement a supportive process for families, assessing the individualized psychosocial and decisional support needs of patients and families to provide foundational data for palliative care consultations. Family Meeting Support: In cases of high medical complexity, uncertainty, value conflicts, or communication issues, the palliative care consultation team supports the facilitation of family meetings. Consultation: The palliative care team provides consultations to the attending physician based on the palliative care needs assessed during family counseling. Topics include symptom management, understanding treatment options, decisional conflict, emotional and practical support, goal of care setting, resources, and bereavement support. Palliative Care by attending Physician: The attending physician incorporates the consultations received from the palliative care consultation team to provide high-quality palliative care to patients and their families.