The provision of care in the intensive care unit (ICU) is based on extremely innovative technology and cutting-edge techniques, often prioritizing the delivery of aggressive treatment to manage the disease while neglecting the human dimension of the patient.
However, in recent times there has been a surge in the introduction of Palliative care in the ICU, which is the focus of this chapter: Palliative care in the intensive cardiac care unit.
In it, Jayne Wood and Maureen Carruthers address the ways in which the implementation of palliative care in the intensive cardiac care unit (ICCU) aims to 1) improve symptom management; 2) help in shared decision making; 3) improve the environment of the unit itself; and 4) introduce a more holistic education and training programs for the healthcare professionals working in the ICCU.
I discovered the field of palliative care when I was an undergraduate at Oxford, studying for a BA in Theology. Initially my approach was academic reading as much academic literature as I could on end-of-life, but in the summer of 2013 I decided to shadow a palliative care doctor at Sobell House Hospice. What I witnessed during that week absolutely fascinated me, particularly the holistic treatment of the multiple dimensions of diseases of people who were terminally ill.
Since then I have been determined to become a palliative care physician myself. Now about to start my second year of medical school, I am that bit closer to attaining my dream.
I have always believed that intensive care was the opposite to palliative care, and therefore never considered that specialty at all. But I have started to appreciate the connection between the two: firstly, by reading the articles of the American intensivist and palliative care physician Jessica Nuttick Zitter in the New York Times and Huffington Post, and more recently through Gabi Heras and the fascinating project, Humanizing Intensive Care (IC-HU Project). This connection is, in fact, not surprising given that palliative care and intensive care share “underlying themes”, as we read in ‘Palliative care in the intensive cardiac care unit’:
“Both focus on the most vulnerable patients in the health care system, and each discipline’s primary goal—extending life for the critical care patient, and comfort and quality of life for the palliative care patient—represents an important secondary goal for the other. Collaboration between SPC [specialist palliative care] and critical care can lead to the provision of optimal EOLC [end of life care], with improvements in symptom control and patient and family satisfaction, as well as lower rates of in-hospital deaths and shorter lengths of stay in hospital.”
I strongly believe that the provision of a human-centered medical care should be the aim of all healthcare professionals in all settings, but this is especially important in places like the ICU where it is easy to miss it. Therefore (and as clearly stated in this chapter) the implementation of palliative care in the ICUs would undoubtedly enable an overall improvement of communication between patients and health care professionals, a holistic control of the symptoms, and a better care after death, thus making ICUs a more human place to be in.
Medical student, Newcastle University (UK)
BA Theology, University of Oxford (UK)