There are many opposing ideas for how to best provide care for patients who are in intensive care. On one side of the fence you have proponents of trying every type of treatment in the hopes of improving the patient’s health, whereas on the other side are advocates of giving comfort care instead
What happens in intensive care?
Patients who enter in to the ICU (intensive care unit) of the hospital are facing formidable challenges. Some percentage of the cases will result in death, although it is by no means a given.
Each situation is different and requires different care. For some patients, it is appropriate for doctors to apply all kinds of treatments, while with others, keeping them stable and providing comfort care is the right way to go.
In cases where the patient is most likely terminal, providing palliative treatment is an important part of the patient’s protocol, but many clinicians that are part of an ICU team are not trained in palliative care, since the ICU is not usually looked at as end of life care.
Intensive care and comfort care
The urgent part of taking care of patients in an ICU is the medical part, doctors doing the best they can to heal and treat, with the goal of recovery.
However, there is an alternative part of treatment that cannot be overlooked, and doctors need to reevaluate the patient’s situation each day to determine whether or not they will continue aggressive treatment or phase it out.
It’s important to retain a multidisciplinary team of doctors to make these delicate and life-altering decisions. As trends in medicine are taking into account the whole of the care, beyond the treatment of the disease, clinicians are becoming aware of the importance of comfort care and changing protocols to meet it.
Making the changes
Part of the recommended protocol for assisting the medical treatment with inpatient palliative care is speaking to the patient’s family and offering them different options. Doctors should listen to their feelings and wishes and use them as part of the patient’s palliative care plan.
One of the hardest decisions to make is when to stop treatment. If the treatment is not brining about the desired results, the family, along the with relevant doctors, may decide to end treatment and focus on providing comfort care to keep the patient out of pain. If the family has a plan that lists the goals of the care plan, it might be easier to make the decision to switch treatment plans when the goals are not being met by rehabilitative treatment.
Why we need to make changes
Studies have shown that there isn’t sufficient communication between doctors and family members in the ICU, and that families are unhappy about it. Communication between doctors and family members can be challenging, since family members often have limited medical knowledge and anxiety on the part of the doctors to talk about the possibility of death. With palliative care training, doctors can learn how to bring up delicate issues and listen to the family members’ feelings and wishes.
At Sinai Post Acute Care Center for Rehabilitation, our doctors are trained in providing comfort care according to the patient’s wishes and dealing with family members about sensitive and important issues.