Regarding the provision of palliative care to ICU patients, outline the advantages and disadvantages of using:
a) A traditional Intensive care consultant - based approach (integrative palliative care).
(50% marks)
b) Palliative care specialty involvement in the ICU by specific consultation (consultative palliative care). (50% marks)
Generally answered well by outlining the limitations of an ICM physician, especially time pressure, care of other critically ill patients and transition of care to the ward. There were multiple references to ICM physicians considering palliation as failure of ICU therapy or having "guilt" which impacts provision of palliative care. Virtually all candidates discussed specific clinical aspects, whereas other aspects such as resources, staffing, and model comparisons, were not addressed.
This answer would work better as a table. The use of the terms "integrative" and "consultative" is not unique but suggests that specific (largely North American) resources were used by the examiners to create this question.
Advantages | Disadvantages |
"Integrative" intensivist-led palliative care | |
|
|
"Consultative" palliative medicine referral | |
|
|
Hill, Stephanie A., et al. "Palliative medicine in the intensive care unit: needs, delivery, quality." BMJ Supportive & Palliative Care 12.1 (2022): 38-41.
Einav, Sharon, Nathan I. Cherny, and J. Randall Curtis. "Palliative medicine in the intensive care unit." Oxford Textbook of Palliative Medicine (2021): 121.
Kościuczuk, Urszula, et al. "Aspects of palliative medicine in intensive care units: A narrative review." Palliative Medicine in Practice (2022).
Stamper, Tara Orgon, Renee Kerr, and Daniela Sporter. "The Evolution of Palliative Medicine in Intensive Care." Critical Care Nursing Quarterly 45.4 (2022): 332-338.
Tomko, Caitlin, et al. "The Practical Implementation of an Embedded Palliative Care Team in a Medical Intensive Care Unit (QI435)." Journal of Pain and Symptom Management 63.5 (2022): 904.
Bhan, Swati, et al. "Palliative Care in Intensive Care Unit." Onco-critical Care: An Evidence-based Approach. Singapore: Springer Nature Singapore, 2022. 515-524.
Ito, Kaori, et al. "Primary palliative care recommendations for critical care clinicians." Journal of Intensive Care 10.1 (2022): 20.
Effendy, Christantie, et al. "Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review." Acute and Critical Care 37.4 (2022): 516-526.
Martins, Belmira DCPCC, Reinaldo A. Oliveira, and Antonio JM Cataneo. "Palliative care for terminally ill patients in the intensive care unit: Systematic review and metaanalysis." Palliative & Supportive Care 15.3 (2017): 376-383.
Carson, Shannon S., et al. "Effect of palliative care–led meetings for families of patients with chronic critical illness: a randomized clinical trial." Jama 316.1 (2016): 51-62.
Strand, Jacob J., and J. Andrew Billings. "Integrating palliative care in the intensive care unit." The journal of supportive oncology 10.5 (2012): 180-187.
Trankle, Steven A. "Is a good death possible in Australian critical and acute settings?: physician experiences with end-of-life care." BMC palliative care 13.1 (2014): 1-14.