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Dying in the ICU: strategies that may improve end-of-life care

[Mourir à l’USI : les stratégies qui peuvent améliorer les soins en fin de vie]

Deborah Cook, MD^*,, Graeme Rocker, DM and Daren Heyland, MD

^* From the Departments of Medicine,
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario;
The Department of Medicine, Dalhousie University, Halifax, Nova Scotia; and
The Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada.

Address correspondence to: Dr. D.J. Cook, Departments of Medicine and Clinical Epidemiology, McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario L8N 3A5, Canada. Phone: 905-525-9140, ext. 22900; Fax: 905-524-3841; E-mail: debcook{at}mcmaster.ca

Purpose: Since 10 to 20% of adult patients admitted to the intensive care unit (ICU) in Canada die, addressing the needs of dying critically ill patients is of paramount importance. The purpose of this article is to suggest some strategies to consider to improve the care of patients dying in the ICU.

Source: Data sources were randomized clinical trials, observational studies and surveys. We purposively selected key articles on end-of-life care to highlight eight initiatives that have the potential to improve care for dying critically ill patients. These initiatives were presented at the International Consensus Conference on End-of-Life Care in the ICU on April 24–25, 2003 in Brussels, Belgium.

Principal findings: We describe eight strategies that, if adopted, may positively impact on the end-of-life care of critically ill patients: 1) promote social change through professional initiatives; 2) legitimize research in end-of-life care; 3) determine what dying patients need; 4) determine what families of dying patients need; 5) initiate quality improvement locally; 6) use quality tools with care; 7) educate future clinicians; and 8) personally engage in end-of-life care. Most of these strategies have not been subjected to rigorous evaluation.

Conclusion: Adoption of some of these strategies we describe may lead to improved end-of-life care in the ICU. Future studies should include more formal evaluation of the efficacy of end-of-life interventions to help us ensure high quality, clinically relevant, culturally adapted care for all dying critically ill patients.

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