End-of-life care in the intensive care unit: A research agenda

Background. The intensive care unit (ICU) represents a unique clinical sett ing in which mortality is relatively high and the professional culture tend s to be one of "rescue therapy" using technological and invasive interventi ons. For these reasons, the ICU is an important environment for understandi ng and improving end-of-life care. Although there have been consensus state ments and review articles on end-of-life care in the ICU, there is limited evidence on which to base an assessment of best practices for providing hig h-quality end-of-life care in this setting. Objective. To convene a Working Group of experts in critical care, palliati ve medicine, medical ethics, and medical law to address the question "What research needs to be done to improve end-of-life care to patients in the IC U?" Methods: Participants were identified for membership in the Working Group b y purposive sampling within the fields of critical care medicine and nursin g, palliative medicine, and medical ethics; others were chosen to represent social work and hospital chaplains. Through a process of breakout and plen ary sessions, the group identified important questions that need to be addr essed in the areas of defining the problem, identifying solutions, evaluati ng solutions, and overcoming barriers. \ Conclusions: Outlining unanswered questions on end-of-life care in the ICU is a first step to providing the answers that will allow us to improve care to patients dying in the ICU. These questions also serve to focus clinicia ns and educators on the important areas for improving quality of care.