European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Jozef Kesecioglu; Katerina Rusinova; Daniela Alampi; Yaseen M. Arabi; Julie Benbenishty; Dominique Benoit; Carole Boulanger; Maurizio Cecconi; Christopher Cox; Marjel van Dam; Diederik van Dijk; James Downar; Nikolas Efstathiou; Ruth Endacott; Alessandro Galazzi; Fiona van Gelder; Rik T. Gerritsen; Armand Girbes; Laura Hawyrluck; Margaret Herridge; Jan Hudec; Nancy Kentish-Barnes; Monika Kerckhoffs; Jos M. Latour; Jan Malaska; Annachiara Marra; Stephanie Meddick-Dyson; Spyridon Mentzelopoulos; Mervyn Mer; Victoria Metaxa; Andrej Michalsen; Rajesh Mishra; Giovanni Mistraletti; Margo van Mol; Rui Moreno; Judith Nelson; Andrea Ortiz Suner; Natalie Pattison; Tereza Prokopova; Kathleen Puntillo; Kathryn Puxty; Samah Al Qahtani; Lukas Radbruch; Emilio Rodriguez-Ruiz; Ron Sabar; Stefan J. Schaller; Shahla Siddiqui; Charles L. Sprung; Michele Umbrello; Marco Vergano; Massimo Zambon; Marieke Zegers; Michael Darmon; Elie Azoulay

doi:10.1007/s00134-024-07579-1

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Jozef Kesecioglu^*, Katerina Rusinova, Daniela Alampi, Yaseen M. Arabi, Julie Benbenishty, Dominique Benoit, Carole Boulanger, Maurizio Cecconi, Christopher Cox, Marjel van Dam, Diederik van Dijk, James Downar, Nikolas Efstathiou, Ruth Endacott, Alessandro Galazzi, Fiona van Gelder, Rik T. Gerritsen, Armand Girbes, Laura Hawyrluck, Margaret HerridgeJan Hudec, Nancy Kentish-Barnes, Monika Kerckhoffs, Jos M. Latour, Jan Malaska, Annachiara Marra, Stephanie Meddick-Dyson, Spyridon Mentzelopoulos, Mervyn Mer, Victoria Metaxa, Andrej Michalsen, Rajesh Mishra, Giovanni Mistraletti, Margo van Mol, Rui Moreno, Judith Nelson, Andrea Ortiz Suner, Natalie Pattison, Tereza Prokopova, Kathleen Puntillo, Kathryn Puxty, Samah Al Qahtani, Lukas Radbruch, Emilio Rodriguez-Ruiz, Ron Sabar, Stefan J. Schaller, Shahla Siddiqui, Charles L. Sprung, Michele Umbrello, Marco Vergano, Massimo Zambon, Marieke Zegers, Michael Darmon, Elie Azoulay

^*Corresponding author for this work

Intensive Care

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Abstract

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Original language	English
Pages (from-to)	1740–1766
Number of pages	27
Journal	Intensive Care Medicine
Volume	50
Issue number	11
DOIs	https://doi.org/10.1007/s00134-024-07579-1
Publication status	Published - 3 Oct 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

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Kesecioglu, J., Rusinova, K., Alampi, D., Arabi, Y. M., Benbenishty, J., Benoit, D., Boulanger, C., Cecconi, M., Cox, C., van Dam, M., van Dijk, D., Downar, J., Efstathiou, N., Endacott, R., Galazzi, A., van Gelder, F., Gerritsen, R. T., Girbes, A., Hawyrluck, L., ... Azoulay, E. (2024). European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. Intensive Care Medicine, 50(11), 1740–1766. https://doi.org/10.1007/s00134-024-07579-1

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title = "European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit",

abstract = "The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.",

author = "Jozef Kesecioglu and Katerina Rusinova and Daniela Alampi and Arabi, {Yaseen M.} and Julie Benbenishty and Dominique Benoit and Carole Boulanger and Maurizio Cecconi and Christopher Cox and {van Dam}, Marjel and {van Dijk}, Diederik and James Downar and Nikolas Efstathiou and Ruth Endacott and Alessandro Galazzi and {van Gelder}, Fiona and Gerritsen, {Rik T.} and Armand Girbes and Laura Hawyrluck and Margaret Herridge and Jan Hudec and Nancy Kentish-Barnes and Monika Kerckhoffs and Latour, {Jos M.} and Jan Malaska and Annachiara Marra and Stephanie Meddick-Dyson and Spyridon Mentzelopoulos and Mervyn Mer and Victoria Metaxa and Andrej Michalsen and Rajesh Mishra and Giovanni Mistraletti and {van Mol}, Margo and Rui Moreno and Judith Nelson and Suner, {Andrea Ortiz} and Natalie Pattison and Tereza Prokopova and Kathleen Puntillo and Kathryn Puxty and Qahtani, {Samah Al} and Lukas Radbruch and Emilio Rodriguez-Ruiz and Ron Sabar and Schaller, {Stefan J.} and Shahla Siddiqui and Sprung, {Charles L.} and Michele Umbrello and Marco Vergano and Massimo Zambon and Marieke Zegers and Michael Darmon and Elie Azoulay",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = oct,

day = "3",

doi = "10.1007/s00134-024-07579-1",

language = "English",

volume = "50",

pages = "1740–1766",

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Kesecioglu, J, Rusinova, K, Alampi, D, Arabi, YM, Benbenishty, J, Benoit, D, Boulanger, C, Cecconi, M, Cox, C, van Dam, M, van Dijk, D, Downar, J, Efstathiou, N, Endacott, R, Galazzi, A, van Gelder, F, Gerritsen, RT, Girbes, A, Hawyrluck, L, Herridge, M, Hudec, J, Kentish-Barnes, N, Kerckhoffs, M, Latour, JM, Malaska, J, Marra, A, Meddick-Dyson, S, Mentzelopoulos, S, Mer, M, Metaxa, V, Michalsen, A, Mishra, R, Mistraletti, G, van Mol, M, Moreno, R, Nelson, J, Suner, AO, Pattison, N, Prokopova, T, Puntillo, K, Puxty, K, Qahtani, SA, Radbruch, L, Rodriguez-Ruiz, E, Sabar, R, Schaller, SJ, Siddiqui, S, Sprung, CL, Umbrello, M, Vergano, M, Zambon, M, Zegers, M, Darmon, M & Azoulay, E 2024, 'European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit', Intensive Care Medicine, vol. 50, no. 11, pp. 1740–1766. https://doi.org/10.1007/s00134-024-07579-1

TY - JOUR

T1 - European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

AU - Kesecioglu, Jozef

AU - Rusinova, Katerina

AU - Alampi, Daniela

AU - Arabi, Yaseen M.

AU - Benbenishty, Julie

AU - Benoit, Dominique

AU - Boulanger, Carole

AU - Cecconi, Maurizio

AU - Cox, Christopher

AU - van Dam, Marjel

AU - van Dijk, Diederik

AU - Downar, James

AU - Efstathiou, Nikolas

AU - Endacott, Ruth

AU - Galazzi, Alessandro

AU - van Gelder, Fiona

AU - Gerritsen, Rik T.

AU - Girbes, Armand

AU - Hawyrluck, Laura

AU - Herridge, Margaret

AU - Hudec, Jan

AU - Kentish-Barnes, Nancy

AU - Kerckhoffs, Monika

AU - Latour, Jos M.

AU - Malaska, Jan

AU - Marra, Annachiara

AU - Meddick-Dyson, Stephanie

AU - Mentzelopoulos, Spyridon

AU - Mer, Mervyn

AU - Metaxa, Victoria

AU - Michalsen, Andrej

AU - Mishra, Rajesh

AU - Mistraletti, Giovanni

AU - van Mol, Margo

AU - Moreno, Rui

AU - Nelson, Judith

AU - Suner, Andrea Ortiz

AU - Pattison, Natalie

AU - Prokopova, Tereza

AU - Puntillo, Kathleen

AU - Puxty, Kathryn

AU - Qahtani, Samah Al

AU - Radbruch, Lukas

AU - Rodriguez-Ruiz, Emilio

AU - Sabar, Ron

AU - Schaller, Stefan J.

AU - Siddiqui, Shahla

AU - Sprung, Charles L.

AU - Umbrello, Michele

AU - Vergano, Marco

AU - Zambon, Massimo

AU - Zegers, Marieke

AU - Darmon, Michael

AU - Azoulay, Elie

PY - 2024/10/3

Y1 - 2024/10/3

N2 - The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

AB - The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

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European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

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