Improving Palliative Care in the ICU
The delivery of outstanding palliative care in the ICU requires knowledge and skill. Our IPAL-ICU list of key resources and presentations for education of professionals across disciplines includes materials in a variety of formats.
General Educational Resources
- American Academy of Hospice and Palliative Medicine (AAHPM)
Offers a variety of educational programs and resources. These include the AAHPM Annual Assembly, which is co-sponsored by the Hospice and Palliative Nurses Association, a series of Webinars, a continuing education curriculum and self-study materials.
- American Association of Critical-Care Nurses (AACN) Self-Assessment in Palliative and End-of-Life Care
Developed by the American Association of Critical-Care Nurses, this is available for free on the AACN Web site and is accompanied by a resource document that provides information on a broad range of palliative care topics.
- Compassionate Care in the ICU
A 20-minute video for health care professionals and a 30-minute video for patients and families featuring interviews with experts in ICU palliative care.
Contact: Society of Critical Care Medicine (SCCM) (847) 827-6888
- Education for Physicians on End-of-Life Care (EPEC)
The Education on Palliative and End-of-Life Care (EPEC) Project educates professionals through several venues including conferences, online learning, and specialized training. The EPEC Curriculum combines didactic sessions, videotape presentations, interactive discussions, and practical exercises. It teaches fundamental palliative care skills in comprehensive assessment, symptom management, communication, ethical decision-making, and psychosocial aspects of care, and includes appendices on areas such as drug choices and mechanisms for reimbursement for services. Multiple modules in the EPEC curriculum are relevant for ICU palliative care and available online with CME credit. The EPEC Project also offers train-the-trainer conferences.
- Educational videos on communication skills from the Stanford Cancer Education Palliative Education Network (CancerPEN)
CancerPEN, part of the eCampus of Stanford University School of Medicine, provides educational videos about topics of relevance beyond care of cancer patients, including communication skills training (modules on Giving Bad News, Setting Goals of Care, Managing Family in Conflict, and others). It is free of charge for clinicians in the U.S. Department of Veterans Affairs.
- End-of-Life Nursing Education Consortium - Critical Care Train-the-Trainer Courses (ELNEC)
A train-the-trainer program, held once or twice annually at a specific location, covering eight curriculum modules. Participants receive up-to-date resources for teaching at their home institutions.
- Fast Facts-from the End-of-Life/Palliative Education Resource Center (EPERC)
EPERC shares educational resource material among professional educators in palliative care including Fast Facts and Concepts-concise, practical, peer-reviewed and evidence-based summaries on key topics for clinicians and trainees. A summary of Fast Facts topics of particular relevance for critical care professionals is provided here.
- Integrating Palliative and Critical Care (IPACC) Video
Educational video based on a research study by the University of Washington End-of-Life Care Research Group, sponsored by the National Institute of Nursing Research, that tested an intervention to Integrate Palliative and Critical Care (IPACC).
- Initiative for Pediatric Palliative Care (IPPC)
Conducts educational retreats throughout the United States and Canada for interdisciplinary teams including clinicians from pediatric and neonatal ICUs, and parents of children with life-threatening conditions. IPPC curriculum materials are available for free on its Web site along with a facilitator's guide. IPPC videos can be purchased. IPPC also makes available other quality improvement tools and resources.
Communication Training Resources
Communicating with Families of Critically Ill Patients: Training Resources
Communicating effectively with ICU families is an essential clinical skill that's optimally taught with active participation by learners receiving supervision and feedback from experienced faculty. The IPAL-ICU Project shares resources from several communication skills training programs using this teaching model.
- Presentations from annual CHEST meetings of the American College of Chest Physicians
Presentations with specific relevance for ICU palliative care include: "Getting on the Same Page," by Dee Ford, MD, MSc, FCCP (2007), and "What Should Be the Physician's Role in Life Support Decisions in ICU?" by Douglas White, MD, MHS (2008).
- Disseminating and Implementing ELNEC-Critical Care in Your Institution
This presentation from the End-of-Life Nursing Education Consortium (ELNEC)-Critical Care curriculum of the American Association of Critical-Care Nurses reviews ICU palliative care initiatives that have successfully disseminated and implemented ELNEC training through a variety of innovative strategies and programs.
- Acute and Critical Care Choices Guide to Advance Directives
This comprehensive document, prepared by the American Association of Critical-Care Nurses, is an educational resource for ICU nurses and others on the legal, ethical and transcultural principles that guide preparation of advance directives.
- CBS News video: "Many find discussing end-of-life care difficult."
In this segment from a CBS newscast in November 2009, Dr. Joseph Lowy, an intensivist and palliative care specialist at Langone Medical Center of New York University, discusses advance care planning.
- 60 Minutes video: "The Cost of Dying"
This segment of the 60 Minutes news program addresses end-of-life issues in the ICU. It features Dr. Ira Byock, a palliative care specialist at Dartmouth-Hitchcock Medical Center in New Hampshire.
- Society of Critical Care Medicine Podcasts
Through iCritical Care on the Society of Critical Care Medicine Web site (www.sccm.org), this organization makes available "radio" podcasts on various topics, including several that are specifically relevant to ICU palliative care, e.g.:
- SCCM Pod-115: Difficult Conversations in the Pediatric ICU (2009).
Elaine Meyer, PhD, RN, Associate Professor of Psychology, Department of Psychiatry, Harvard Medical School, and Director of the Institute for Professionalism and Ethical Practice at Children's Hospital Boston, discusses a paper published in Pediatric Critical Care Medicine titled "Difficult Conversations: Improving Communication Skills and Relational Abilities in Healthcare" (Pediatr Crit Care Med. 2009;10:352-59).
- SCCM Pod-41 CCM: Tough Decisions at the End of Life (2006).
Douglas White, MD, discusses his article "Decisions to Limit Life-Sustaining Treatment for Critically Ill Patients Who Lack Both Decision-Making Capacity and Surrogate Decision Makers" (Crit Care Med. 2006; 34:2053-59).
- December 2005 CC: Pediatric End of Life (2005).
Robert Truog, MD, FCCM, of Harvard Medical School, Children's Hospital Boston, discusses his article "Pediatric End of Life: Special Needs for Special Children" (Crit Conn 2005; 4:9).
- December 2005 CC: Improving Family Conferences About End of Life (2005).
J. Randall Curtis, MD, MPH, discusses his article "Improving Family Conferences About End-of-Life Care in the ICU." Dr. Curtis offers techniques and procedures associated with "successful" family conferences (Crit Conn 2005; 4:5).
- SCCM Pod-90 CCM: New End-of-Life Guidelines (2008).
Robert D. Truog, MD, MA, discusses new guidelines published in Critical Care Medicine 2008, "Recommendations for End-of-Life Care in the ICU" (Crit Care Med. 2008; 36:953-63).
- SCCM Pod-72 PCCM: Family Presence at Pediatric CPR (2007). Susan Bratton, MD, MPH, discusses an editorial published in Pediatric Critical Care Medicine 2006, "Physician Experience with Family Presence During Pediatric Cardiopulmonary Resuscitation" (Niranjan K. Pediatr Crit Care Med. 2006; 7:505).
- December 2005 CC: Getting Our ICU Language Straight (2005). Karin Kirchhoff, PhD, RN, FAAN, Professor Emerita at the University of Wisconsin-Madison School of Nursing, discusses her article "Getting Our ICU Language Straight." She emphasizes the importance of clinicians' sensitivity to the language they use and involvement of the family at every stage of care (Crit Conn 2005; 4:1).
- Presentation on Chronic Critical Illness
The Critical Care Web site of the American Thoracic Society provides educational materials in various formats (including downloadable presentations) on a range of subjects relevant to ICU palliative care, such as this presentation by expert David Nierman, MD, MMM.