Critically ill patients in intensive care units (ICUs) receive life-sustaining treatments aimed at restoring or maintaining organ function. ICU admission often involves substantial physical and existential pressures that can burden patients, their families, and surrogates. Multidisciplinary palliative care support can help alleviate potential causes of suffering. Twenty patients admitted to the ICUs at Seoul National University Hospital, diagnosed with sudden and severe acute brain injury or progressive organ failure, along with their surrogates, will be enrolled in the study. This study aims to assess the feasibility of applying consultation-based palliative care services to provide higher quality palliative care for critically ill patients with acute illnesses and their families facing poor prognoses upon ICU admission. Additionally, the study seeks to determine whether providing such palliative care services can help better respect the patient's values and goals, reduce communication conflicts, alleviate family caregivers' anxiety and depression, and enhance satisfaction with critical care.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
20
Family Counseling: Social workers implement a supportive process for families, assessing the individualized psychosocial and decisional support needs of patients and families to provide foundational data for palliative care consultations. Family Meeting Support: In cases of high medical complexity, uncertainty, value conflicts, or communication issues, the palliative care consultation team supports the facilitation of family meetings. Consultation: The palliative care team provides consultations to the attending physician based on the palliative care needs assessed during family counseling. Topics include symptom management, understanding treatment options, decisional conflict, emotional and practical support, goal of care setting, resources, and bereavement support. Palliative Care by attending Physician: The attending physician incorporates the consultations received from the palliative care consultation team to provide high-quality palliative care to patients and their families.
Seoul National University Hospital
Seoul, N/A (Not Applicable), South Korea
RECRUITINGFeasibility of Applying Consultation-Based High-Quality Palliative Care
Proportion of eligible contacts who consented and participated in the study, palliative care family counseling rate, and study completion rate.
Time frame: 1 day (at discharge)
Change in Surrogates' Decisional Conflict before and after the Intervention
The Decisional Conflict Scale (DCS) is a validated tool designed to evaluate personal uncertainty when making healthcare decisions, including modifiable factors that contribute to such uncertainty and the overall quality of the decision. It consists of 16 questions, each rated on a 5-point scale from "strongly agree" (1) to "strongly disagree" (5). Scores range from 16 to 80, with higher scores reflecting greater uncertainty and less favorable outcomes.
Time frame: Pre-post comparison (baseline vs. within one week after consultation)
Change in Surrogates' Decisional Self-Efficacy before and after the Intervention
The Decisional Self-Efficacy Scale (DSES) evaluates an individual's self-confidence or belief in their decision-making abilities, including the ability to participate in shared decision making. The scale consists of 11 items, each rated on a five-point Likert scale from "0" (no confidence) to "4" (very confident). To determine the total score, the sum of the item scores is divided by 11 and then multiplied by 25. Scores range between 0 and 100, with higher scores indicating higher levels of decision-making self-efficacy.
Time frame: Pre-post comparison (baseline vs. within one week after consultation)
Change in Surrogates' Emotional State before and after the Intervention
The Hospital Anxiety and Depression Scale (HADS) is a questionnaire consisting of fourteen items. Seven items focus on anxiety, while the other seven address depression. Scores for each subscale range from 0 to 21, with higher scores reflecting higher levels of anxiety or depression.
Time frame: Pre-post comparison (baseline vs. within one week after consultation)
Surrogates' Decision Regret after the Intervention
The Decision Regret Scale (DRS) is a 5-item, 5-point Likert-type self-report measure used to assess distress or remorse following a healthcare decision. Items are rated from 1 ("strongly agree") to 5 ("strongly disagree"), with two items (2 and 4) phrased negatively. To calculate the total score, the negatively phrased items are first reversed, then the mean of all five items is computed. This mean is rescaled from 0 to 100 by subtracting 1 and multiplying by 25. A score of 0 represents no regret, while 100 indicates a high level of regret.
Time frame: Follow-up (within one week after consultation and one month after consultation; up to three months after the final consultation for deceased patients)
Level of Patient- and Family-Centered Care Experienced by Surrogates after the Intervention
The Modified Patient Perception of Patient-Centeredness (PPPC) scale, utilized by surrogates, consists of 12 items. The scores range from 0 to 100, with higher scores indicating a higher level of patient-centered care.
Time frame: Follow-up (within one week after consultation and one month after consultation; up to three months after the final consultation for deceased patients)
Surrogates' Satisfaction with the Intervention Services
Overall satisfaction with ICU palliative care, family counseling satisfaction, consultation satisfaction, and family meeting satisfaction, assessed on a 5-point scale (very dissatisfied, dissatisfied, neutral, satisfied, very satisfied)
Time frame: Within one week after the final consultation
Length of Hospital Stay
Length of ICU stay and overall hospital stay
Time frame: 1 day (at discharge)
Survival to Discharge Rate
Vital status at discharge
Time frame: 1 day (at discharge)
Days of Symptom Relief Treatments received in the ICU
Number of days receiving comfort-focused care (opioids and/or antipsychotics) during the ICU stay, based on a retrospective review of medical records
Time frame: 1 day (at discharge)
Proportion of Patients receiving Symptom Relief Treatments During the ICU stay
The percentage of the total study population who received comfort-focused care (opioids and/or antipsychotics) during the ICU stay, based on a retrospective review of medical records
Time frame: 1 day (at discharge)
Use of Life-Sustaining Procedures within 48 Hours before Death
We assessed the life-sustaining procedures administered during the end-of-life (EOL) stage using seven indicators: cardiopulmonary resuscitation (CPR), mechanical ventilation, continuous renal replacement therapy, surgery, vasopressors, extracorporeal membrane oxygenation (ECMO), and high-flow oxygen (HFO2). The percentage of the total study population that received each procedure within the last 48 hours of life was measured.
Time frame: 1 day (at discharge)
Use of Symptom Relief Treatments within 48 Hours before Death
Administration of opioid analgesics and/or antipsychotic medications within the final 48 hours of life was regarded as receiving end-of-life comfort care. We analyzed the percentage of the total study population that received opioid analgesics and/or antipsychotic medications during the last 48 hours of life.
Time frame: 1 day (at discharge)
Data Collection Completion Rate
Proportion of data collected at each time point exceeding 90%
Time frame: Within three months after the final consultation
Time Taken to Recruit Patients
Time interval between enrollment of the first and tenth patients
Time frame: Within the first year of study initiation
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.