Topic
Palliative care
Symptom control, communication, and decision-making in advanced disease.
What the evidence shows
Changing the default works better than persuading clinicians. Making palliative care consultation an opt-out order sharply increased referrals across 24,065 seriously ill patients (Courtright 2024).
But more communication does not reliably reduce family distress. A family-support intervention delivered by the treating ICU team improved ratings of communication and shortened ICU stay without easing surrogates' anxiety and depression (PARTNER). Structured meetings led by palliative care specialists who did not know the family did worse still: no reduction in anxiety or depression, and *higher* post-traumatic stress symptoms (Carson 2016). Continuity may be the active ingredient.
Be careful what you promise about recovery. Clinicians predict survival reasonably well and functional outcome poorly (Detsky 2017) — and functional outcome is what families are actually asking about.
Supporting families
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| PARTNER | 2018 | Interprofessional family-support intervention | Structured family support improved communication and shortened ICU stay without easing families' distress | |
| Carson 2016 | 2016 | Palliative care-led family meetings | Palliative care-led family meetings did not reduce distress and increased post-traumatic stress symptoms |
Predicting outcomes
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| Detsky 2017 prospective cohort | 2017 | Clinician prediction | Clinicians predicted survival reasonably well and functional recovery poorly |
Triggering palliative care
| Trial | Year | Therapy | Effect | Finding |
|---|---|---|---|---|
| Courtright 2024 | 2024 | Default palliative care consultation order | Making palliative care consultation the default nearly tripled referrals but did not change length of stay |
Key references
Guidelines, standards and reviews for this topic.
- Practical Guidance
- Scheunemann LP, Arnold RM, White DB. The facilitated values history: helping surrogates make authentic decisions for incapacitated patients with advanced illness. Am J Respir Crit Care Med 2012 Sep 15;186(6):480-6. PMID 22822020
- Billings JA, Block SD. The end-of-life family meeting in intensive care part III: A guide for structured discussions. J Palliat Med 2011 Sep;14(9):1058-64. PMID 21910613
- Society Statements & Guidelines
- Marshall MF, Davis FD, Fogelman PA, et al. Society of Critical Care Medicine Clinical Practice Guidelines on Adult End-of-Life Care in the ICU. Crit Care Med 2025 Dec 1;53(12):e2734-e2746. PMID 41342842
- Sullivan DR, Iyer AS, Enguidanos S, et al. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement. Am J Respir Crit Care Med 2022 Sep 15;206(6):e44-e69. PMID 36112774
- Bosslet GT, Pope TM, Rubenfeld GD, et al. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med 2015 Jun 1;191(11):1318-30. PMID 25978438
- Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med 2008 Mar;36(3):953-63. PMID 18431285
- Lanken PN, Terry PB, Delisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008 Apr 15;177(8):912-27. PMID 18390964