Palliative care is not just for the dying

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Address the comfort needs of all ICU patients

Dr. Geoffrey P. Dunn

This is an excellent perspective on the ongoing assimilation of palliative care principles and practices into the venue where it is most needed. Dr. Cooper, who is board certified in hospice and palliative medicine in addition to her surgical certification, is eminently qualified to speak to this topic. She represents a new generation of surgeons who see the potential for palliative care principles and practices for all seriously ill surgical patients.

She is right in suggesting we understand palliative care as a way of caring, not a prognostic indicator. As far back as 1999, intensivist and pulmonologist Judith Nelson argued in a memorable editorial in Annals of Internal Medicine that we should not try to pick and choose who needs palliative care in the ICU setting because prognosis is so hard to determine, but rather meet the comfort and quality of life needs of all ICU patients and their families.

Geoffrey P. Dunn, M.D., an ACS Fellow based in Erie, Pa., is chair of the ACS Surgical Palliative Care Task Force.



The triggers also shouldn’t focus only on the patients most obviously likely to die or they will perpetuate the misconception that palliative care is only for the dying, she added.

To integrate palliative care into an ICU, "just do it," she said. "Commit yourself" to intensive symptom management and multidisciplinary family meetings within 72 hours of ICU admission. Institute an intensive communication plan to provide emotional, educational, and decision support for patients and families. Offer pastoral and psychosocial support. Start end-of-life-care discussions sooner, and provide bereavement services when patients die.

Lastly, don’t hesitate to bill insurers for these services, Dr. Cooper said. In-person or phone meetings about treatment options when the patient lacks the capacity to decide can be billed as critical care, as can discussions about DNR codes. Also bill for treating acute pain, agitation, delirium, and other life-threatening symptoms as critical care.

Dr. Cooper reported having no financial disclosures.

On Twitter @sherryboschert


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