Table 4.

Pros and cons of the main models for integrating palliative care in the intensive care unit

Model	Consultation by Palliative Care Service	Integration by Critical Care Team in Daily ICU Practice
Advantages	Expert input from interdisciplinary team of specialists Expertise already exists, additional training unnecessary Empirical evidence of benefit Continuity of care before, during and after ICU Facilitation of transfer out of ICU for end-of-life care, if appropriate	Availability of palliative care for all ICU patients and families Palliative care service not required Clearly acknowledges importance of palliative care as core element of intensive care Systematization of ICU work processes promotes reliable performance of palliative care
Disadvantages	Requires palliative care service with adequate staffing and other resources Palliative care clinicians may be seen as “outsiders” in ICU Consultants may lack familiarity with biomedical and nursing aspects of critical care Activities of palliative care and ICU teams may overlap and/or conflict Consultants must rapidly establish effective relationship with patients/families Fragmentation of care may be compounded ICU team may have less incentive to improve palliative care knowledge and skills	Requires education of ICU clinicians in palliative care knowledge and skills Depends on commitment of critical care clinicians and supportive ICU culture Requires dedication of staff and other resources that may be lacking in ICU Requires handoff to new team for post-ICU palliative care for patients who cannot benefit from or no longer need the ICU

ICU, intensive care unit.