Integrating palliative and critical care: Description of an intervention

Patsy D. Treece, Ruth A. Engelberg, Sarah E. Shannon, Elizabeth L. Nielsen, Theresa Braungardt, Gordon D. Rubenfeld, Kenneth P. Steinberg, J. Randall Curtis

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.

Original languageEnglish (US)
Pages (from-to)S380-S387
JournalCritical care medicine
Issue number11 SUPPL.
StatePublished - Nov 2006


  • Critical care
  • Death
  • Dying
  • End-of-life care
  • Intensive care
  • Palliative care
  • Withdrawing life support

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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