Caring for patients with critical illness and their families: the value of the integrated clinical team

Because of the severity of illness, the intensive care unit (ICU) is a setting where death is common. Approximately 20% of all deaths in the United States occur in ICUs. Although optimal palliative care of out-patients may prevent many ICU admissions, the ICU will always remain an important setting for end-of-life care because of the severity of illness of patients in the ICU. This review provides an overview of the principles and practice of integrating palliative and critical care, with a focus on 4 specific areas: the role of palliative care in the ICU; symptom assessment and management; communication with patients and family members; and interdisciplinary communication and collaboration. This review also describes the development and evaluation of a new intervention for hospitals and individual ICUs: Integrating Palliative and Critical Care (IPACC). The goal of the IPACC intervention and this paper is to teach ICU clinicians basic palliative care skills and the language of palliative care, and to encourage all ICU clinicians to prioritize palliative care as one of the important things that we do in the ICU.