Care near the end-of-life in critically ill patients: a North American perspective

Purpose of reviewEnd-of-life care for critically ill patients has emerged as an area in which significant quality improvement is possible. In this article, we present a North American perspective on recent research and quality improvement initiatives in this field. Recent findingsSome of the most important recent developments in end-of-life care in the intensive care unit concern physician-patient-family communication. There is consensus between North American and European professional societies that a shared approach to decision-making by physicians and family members is optimal. The shared decision approach demands that physicians not only skillfully elicit the patient's treatment preferences but also effectively inform the family of the patient's clinical condition and prognosis. Moreover, the ultimate responsibility for end-of-life treatment decisions is shared between the physician and the patient or family. SummaryThis update presents a North American perspective on six topics of particular importance to end-of-life care in the intensive care unit: (a) The role of advance directives, (b) shared decision-making and the role of the family, (c) conflict and futility in the intensive care unit, (d) cultural aspects of end-of-life care, (e) multidisciplinary care in the intensive care unit, and (f) future directions for improving end-of-life care in the intensive care unit.