Table 3.

Examples of Intensive Care Unit-Based Palliative Care Interventions and Representative Studies

Primary target	Examples	Summary of findings	Sample of references
Patient	NONE
Family	Intervention booklet for family; intensive nurse-, social worker-, or physician-led communication; standardized or structured family meetings; family support coordinator or navigator; family presence during ICU rounds	Mixed—no effect or change in family satisfaction or depression scores, reduced ICU LOS, reduced nonconsensus between ICU clinicians and families; increased DNR and comfort care orders; increased order choosing aggressive interventions; improved frequency of communication with ICU providers; decreased ICU costs	Curtis et al.57; Daly et al.89; Medland and Ferrans90; Lilly et al.91,92; Azoulay et al.93; Burns et al.94; Jacobowski et al.95; Ahrens et al.96; Shelton et al.97
Clinician team	Education about ethics; education about communication skills; Palliative care team rounds with ICU team	Increased proportion of ICU patients receiving palliative care consultation; reduced ICU LOS	Holloran et al.98; Villarreal et al.99
System	Palliative care or comfort care order set	No change; increased pastoral care involvement; reduced hospital LOS	Treece et al.100; Hall et al.101
Multilevel	Palliative care consultation; ethics team consultation; transition of patient out from ICU team to comprehensive support care team; ICU clinician education about communication and more frequent and intensive communication with family; clinician education about palliative care communication with designation of local champions and standardized comfort care order sets; communication facilitator	No change; reduced ICU and hospital LOS; reduced treatment intensity; reduced depression, anxiety, and PTSD prevalence among family members; improved nurse QODD scores; increased frequency of family conferences; increased frequency of prognosis being discussed in family conferences; increased DNR status designation	Lautrette et al.46; Norton et al.47; Carlson et al.48; Schneiderman et al.50,56; Field et al.102; Dowdy et al.103; Campbell and Guzman44,104; Curtis et al.45,57,105; Lamba et al.106