Incorporating palliative care into critical care education: Principles, challenges, and opportunities

Critical Care Medicine

Volumn 27, Issue 9, 1999, Pages 2005-2013

  Danis, Marion ^a   Federman, Daniel ^b   Fins, Joseph J ^b   Fox, Ellen ^b   Kastenbaum, Beatrice ^b   Lanken, Paul N ^b   Long, Karen ^b   Lowenstein, Edward ^b   Lynn, Joanne ^b   Rouse, Fenella ^b   Tulsky, James ^b  

^a NATIONAL INSTITUTES OF HEALTH   (United States)

^b NONE

Author keywords

Barriers; Cardiopulmonary resuscitation; Consensus; Death; Goals; Intensive care; Life sustaining treatment; Medical education; Opportunities; Palliative care; Principles; Skills

Indexed keywords

ARTICLE; CULTURAL FACTOR; DOCTOR PATIENT RELATION; EDUCATION PROGRAM; HUMAN; INTENSIVE CARE; MEDICAL DECISION MAKING; MEDICAL EDUCATION; PALLIATIVE THERAPY; PRIORITY JOURNAL; RESUSCITATION;

DEATH AND EUTHANASIA; EMPIRICAL APPROACH;

ATTITUDE TO DEATH; CRITICAL CARE; CURRICULUM; EDUCATION, MEDICAL; HUMANS; INTENSIVE CARE UNITS; MODELS, EDUCATIONAL; PALLIATIVE CARE; PHYSICIAN-PATIENT RELATIONS; TERMINAL CARE; UNITED STATES;

EID: 0032859093     PISSN: 00903493     EISSN: None     Source Type: Journal    
DOI: 10.1097/00003246-199909000-00047     Document Type: Article

References (59)

1. 1. The SUPPORT Principal Investigators: A controlled trial to improve care for terminally ill hospitalized adults. JAMA 1995; 274: 1591-1598
2. 2. Wanzer SH, Adelstein SJ, Cranford RE, et al: The physician's responsibility toward hopelessly ill patients. N Engl J Med 1984; 310: 955-959
3. 3. Wanzer SH, Federman DD, Adelstein SJ, et al: The physician's responsibility toward hopelessly ill patients. N Engl J Med 1989; 320:844-849
4. 4. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: Deciding to Forgo Life-Sustaining Treatment. Washington, DC, US Government Printing Office, 1983
5. 5. The Hastings Center: Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. Bloomington, IN, University Press, 1987
6. 6. The Appleton Consensus: Suggested international guidelines for decisions to forgo medial treatment. J Med Ethics 1989; 15: 129-136
7. 7. Society of Critical Care Medicine Ethics Task Force, Society of Critical Care: Medicine Consensus Statement on Forgoing Life-Sustaining Treatments in the Critically III. Crit Care Med 1990; 18:1435-1439
8. 8. Council on Ethical and Judicial Affairs, American Medical Association: Guides for the appropriate use of do-not-resuscitate orders. JAMA 1991; 265:1868-1871
9. 9. American Thoracic Society: Withholding and withdrawing life-sustaining therapy. Am Rev Respir Dis 1991; 144:726-731
10. 10. Council on Scientific Affairs, American Medical Association: Good care of the dying patient. JAMA 1996; 275:474-478
11. 11. American Board of Internal Medicine: Caring for the Dying: Identification and Promotion of Physician Competency. Philadelphia, PA, American Board of Internal Medicine, 1996
12. 12. Institute of Medicine Committee on Care of the Dying: Approaching Death: Care at the End of Life. Washington, DC, National Academy Press, 1997
13. 13. Knaus WA, Wagner DP, Zimmerman JE, et al: Variations in mortality and length of stay in intensive care units. Ann Intern Med 1993; 118:753-761
14. 14. Block SD, Bernier GM, Crawley LM, et al: Incorporating palliative care into primary care education. J Gen Intern Med 1998; 13: 768-773
15. 15. Billings JA, Block SD: Palliative care in undergraduate medical education: Status report and future directions. JAMA 1997; 278: 733-738
16. 16. Fink A, Kosecoff J, Chassin M, et al: Consensus methods: characteristics and guidelines. Am J Public Health 1984; 74:979-983
17. 17. Danis M: Improving end-of-life care in the intensive care unit: What's to be learned form outcomes research? New Horiz 1998; 6:110-118
18. 18. Lomas J: Words without action? The production, dissemination, and impact of consensus recommendations. Annu Rev Public Health 1991; 12:41-65
19. 19. Berenson RA: Intensive Care Units (ICUs): Clinical Outcomes, Costs, and Decisionmaking (Health Technology Case Study 28), Office of Technology Assessment, Washington, DC, November, 1984
20. 20. Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: A severity of disease classification system. Crit Care Med 1985; 13:818-829
21. 21. Knaus WA, Wagner DP, Lynn J: Short term mortality predictions for critically ill hospitalized adults: Science and ethics. Science 1991; 254:389-394
22. 22. Lynn J, Teno JM, Harrell FE Jr: Accurate prognostications of death: Opportunities and challenges for clinicians. West J Med 1995; 163(Suppl):250-257
23. 23. Smedira NG, Evans BH, Grais LS, et al: Withholding and withdrawal of life support from the critically ill. N Engl J Med 1990; 322: 309-315
24. 24. Faber-Langendoen K: A multi-institutional study of care given to patients dying in hospitals: Ethical practices and implications. Arch Intern Med 1996; 156:2130-2136
25. 25. Koch KA, Rodeffer HD, Wears RL: Changing patterns of terminal care management in an intensive care unit. Crit Care Med 1994; 22: 233-242
26. 26. Prendergast TJ, Luce JM: Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med 1997; 155:15-20
27. 27. Corr CA, Corr DM (Eds): Hospice Care: Principles and Practice. New York, Springer Publishing, 1983
28. 28. Doyle C, Hanks GW, MacDonald N (Eds): Oxford Textbook of Palliative Care Medicine. Oxford, UK, Oxford Medical Publications, 1993
29. 29. Billings JA: Medical education for hospice care: A selected bibliography with annotations. Hosp J 1993; 9:69-83
30. 30. McDonald N, Mount B, Boston W, et al: The Canadian palliative care undergraduate curriculum. J Cancer Educ 1993; 8:197-201
31. 31. American Board of Internal Medicine: Caring for the Dying: Identification and Promotion of Physician Competency. Philadelphia, American Board of Internal Medicine, 1996
32. 32. Brody H, Campbell ML, Faber-Langendoen K, et al: Withdrawing intensive life-sustaining treatment - recommendations for compassionate clinical management. N Engl J Med 1997; 336:652-657
33. 33. Cook DJ, Guyatt GH, Jaeschke R, et al: Determinants in Canadian health care workers of the decision to withdraw life support from the critically ill. JAMA 1995; 273:703-708
34. 34. Steele RG, Fitch MI: Needs of family caregivers of patients receiving home hospice care for cancer. Oncol Nurs Forum 1996; 23: 823-828
35. 35. Kuczewski MG: Reconceiving the family: The process of consent in medical decisionmaking. Hastings Cent Rep 1996; 26:30-37
36. 36. Society of Critical Care Medicine Ethics Committee: Consensus statement on the triage of critically ill patients. JAMA 1994; 271: 1200-1203
37. 37. American Thoracic Society: Fair allocation of intensive care unit resources. Am J Respir Crit Care Med 1997; 156:1282-1301
38. 38. Schneiderman LJ, Jecker NS, Jonsen AR: Medical futility: Its meaning and ethical implications. Ann Intern Med 1990; 112: 949-954
39. 39. Truog RD, Brett AS, Frader J: The problem with futility. N Engl J Med 1992; 326: 1560-1564
40. 40. Esserman L, Belkora J, Lennert L: Potentially ineffective care: A new outcome to assess the limits of care. JAMA 1995; 274: 1544-1551
41. 41. Murray LS, Teasdale GM, Murray GD, et al: Does prediction of outcome alter patient management? Lancet 1993; 341:1487-1491
42. 42. Curtis JR, Park DR, Krone MR, et al: Use of the medical futility rationale in do-not attempt resuscitation orders. JAMA 1995; 273: 124-128
43. 43. Klessig J: The effect of values and culture on life-support decisions. West J Med 1992; 157: 316-322
44. 44. Vincent JL: European attitudes towards ethical problems in intensive care medicine: Results of an ethical questionnaire. Intensive Care Med 1990; 16:256-264
45. 45. Beauchamp TL, Childress JF: Principles of Biomedical Ethics. Fourth Edition. Oxford University Press, New York, 1994
46. 46. Meisel A: Legal myths about terminating life support. Arch Intern Med 1991; 151: 1497-1502
47. 47. Danis M: Following advance directives. Hastings Cent Rep 1994; 24:521-523
48. 48. Sehgal A, Galbraith A, Chesney M, et al: How strictly do dialysis patients want their advance directives followed? JAMA 1992; 267: 59-63
49. 49. Emanuel L, Danis M, Pearlman R,: Advance care planning as a process: Structuring the discussion in practice. J Am Geriatr Soc 1995; 43:440-446
50. 50. Quill TE, Dresser R, Brock DW: The rule of double effect - A critique of its role in end-of-life decision-making. N Engl J Med 1997; 337:1768-1771
51. 51. Williams ML: An algorithm for selecting a communication technique with ventilated patients. Dimens Crit Care Nurs 1992; 11: 222-233
52. 52. American Pain Society: Principles of Analgesic Use in the Treatment of Acute Pain and Chronic Cancer Pain. Skokie, IL, American Pain Society, 1989
53. 53. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer: The management of chronic pain in patients with breast cancer. Can Med Assoc J 1998; 158(Suppl 3):S71-S81
54. 54. Bascom PB, Tolle SW: Care of the family when the patient is dying. West J Med 1995; 163:292-296
55. 55. Whitfield JM, Siegel RE, Glickman AD: The application of hospice concepts to neonatal care. Am J Dis Child 1982; 136:421-424
56. 56. Dowdy M, Robertson C, Bander JA: A study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stay. Crit Care Med, 1998; 26: 252-259
57. 57. Field B, Devich LE, Carlson RW: Impact of a comprehensive supportive care team on management of hopelessly ill patients with multi-organ failure. Chest 1989; 96:353-356
58. 58. Campbell ML, Field BE: Management of the patient with do not resuscitate status: Compassion and cost containment. Heart Lung 1991; 20:345-348
59. 59. Miller FG, Fins JJ: A proposal to restructure hospital care for dying patients. N Engl J Med 1996; 334:1740-1742