Suboptimal end-of-life (EOL) care in the Intensive care unit (ICU)

Section 1 : reason for sub optimal end of lie care in the icu
-Barrier to goal of care discussion
– complexity of substitute decision maker
– difficult of implementing palliative care in icu

Second 2: consequence when getting sub optimal end of life care I. Icu
– consequence of barrier of goal discussion
– consequence of complexity of substitute decision maker
– consequence of poor implementation of palliative care in icu

Section 3 : intervention that improve end of life care in icu
– intervention. To improve goal of care discussion
– intervention to help the choice of substitute decision maker as well as help substitute deiciosn maker make patient Centered care
– intervention to improve palliative care in icu

Below is are more details outline with associated reference but i need more references regarding implement of palliative care in icu and how to improve them .

Paper instructions
My thesis statement is: Death and Dying is a reality in the intensive care unit, however, however the litterature reports there IS suboptimal end-of-life (EOL) care in the Intensive care unit (ICU) A review of the literature identifies three common themes that contribute to poor EOL care in the ICU, barriers to the goal of care discussion, complexities of surrogate decision-making, and poor integration of palliative care in the ICU.
This is the style I want my paper
Section one of the barrier to end of life care in the Intensive care unit 6 pages
part one of section 1 :barrier of goal of care discussion addressing these two themes
( 2 pages )
1)barrier from the heatlh care worker prospective

You, J. J., Downar, J., Fowler, R. A., Lamontagne, F., Ma, I. W. Y., Jayaraman, D., Kryworuchko, J., Strachan, P. H., Ilan, R., Nijjar, A. P., Neary, J., Shik, J., Brazil, K., Patel, A., Wiebe, K., Albert, M., Palepu, A., Nouvet, E., des Ordons, A. R., Heyland, D. K. (2015). Barriers to Goals of Care Discussions With Seriously Ill Hospitalized Patients and Their Families. JAMA Internal Medicine, 175(4), 549. https://doi.org/10.1001/jamainternmed.2014.7732

Wilson, M. E., Akhoundi, A., Krupa, A. K., Hinds, R. F., Litell, J. M., Gajic, O., & Kashani, K. (2014). Development, validation, and results of a survey to measure understanding of cardiopulmonary resuscitation choices among ICU patients and their surrogate decision makers. BMC Anesthesiology, 14(1), 15. https://doi.org/10.1186/1471-2253-14-15 Wilson, M. E., Kaur, S., Gallo De Moraes, A., Pickering, B. W., Gajic, O., & Herasevich, V. (2015). Important clinician information needs about family members in the intensive care unit. Journal of Critical Care, 30(6), 13171323. https://doi.org/10.1016/j.jcrc.2015.07.028
2) 2) 2 barrier from the patient and family prospective

You,
J. J., Dodek, P., Lamontagne, F., Downar, J., Sinuff, T., Jiang, X., Day, A. G., & Heyland, D. K. (2014). What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families. Canadian Medical Association Journal, 186(18), E679E687. https://doi.org/10.1503/cmaj.140673 Aleksova, N., Demers, C., Strachan, P. H., MacIver, J., Downar, J., Fowler, R., Heyland, D. K., Ross, H. J., & You, J. J. (2016). Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire. ESC Heart Failure, 3(4), 245252. https://doi.org/10.1002/ehf2.12096 Note : always tie it back to this negatively impact goals of care

2a) complexity of substitue decision maker using these 4 reference addressing the following complexity of substitute decision makers focusing on these three thems 1)

1)Difficult of picking a Substiture decision maker 2) 2)Diffuculty of making a desicion when the subtitue decision maker is a trustee of the government 3) 3)Difficult of substitue decision maker of making goal of care decision.

Kryworuchko, J., Strachan, P. H., Nouvet, E., Downar, J., & You, J. J. (2016). Factors influencing communication and decision-making about life-sustaining technology during serious illness: a qualitative study. BMJ Open, 6(5), e010451. https://doi.org/10.1136/bmjopen-2015-010451

Quinn, T., Moskowitz, J., Khan, M. W., Shutter, L., Goldberg, R., Col, N., Mazor, K. M., & Muehlschlegel, S. (2017). What Families Need and Physicians Deliver: Contrasting Communication Preferences Between Surrogate Decision-Makers and Physicians During Outcome Prognostication in Critically Ill TBI Patients. Neurocritical Care, 27(2), 154162. https://doi.org/10.1007/s12028-017-0427-2 https://www.scu.edu/ethics/focus-areas/bioethics/resources/conserved-patient/medical-decision-making-for-publicly-conserved-/
Part 3 : barrier to integration of palliative care in the ICU : use this one article to outline the 3 theme of barrier to inter gratuit of palliative care in icu but then find more article
article. Article 1: Kyeremanteng, K., Beckerleg, W., Wan, C., Vanderspank-Wright, B., DEgidio, G., Sutherland, S., Hartwick, M., Gratton, V., & Sarti, A. J. (2020). Survey on Barriers to Critical Care and Palliative Care Integration. American Journal of Hospice and Palliative Medicine, 37(2), 108116. https://doi.org/10.1177/1049909119867658

Section 2 the consequences of poor end of life care in the ICU

using these 4 articles focusing on these three themes Seciton 3
Consequence resulting from poor goal of care discussion Decreased quality of care particularly end of life care (EOLC) (Secunda et al., 2020; Suen et al., 2020a; Turnbull et al., 2019).
Unwanted intervention medical intervention resulting in suffering Emiloju et al., 2020)
. Poor understand of prognosis of prognosis and diagnosis (Howard et al., 2021; Wilson et al., 2014).

Complexity of substitute decision maker
Increase family conflict (Scheunemann et al., 2019; Secunda et al., 2020; Suen et al., 2020a; Turnbull et al., 2019).
Increased incidence of anxiety, depression for patient and substitute decision makers (Quinn et al., 2017; Wilson et al., 2015).

Intevention to improve GOAL of care discusion
Early Timing of goal of care discussion

Implement strategies to facilitate, more time-responsive GOC discussions by
-implementing daily prognostic assessments, such as the Clinical Frailty Scale, which can then be used to trigger earlier GOC discussions between the patient or SDM and the HCP (Orford et al., 2019).
-In addition, the use of mortality prediction scores such as DeepSOFA: A Continuous Acuity Score for Critically Ill (Shickel et al., 2019, p.1) can help the HCP clarify the patient diagnosis and prognosis during GOC discussions.
Shickel, B., Loftus, T. J., Adhikari, L., Ozrazgat-Baslanti, T., Bihorac, A., & Rashidi, P. (2019). DeepSOFA: A Continuous Acuity Score for Critically Ill Patients using Clinically Interpretable Deep Learning. Scientific Reports, 9(1), 1879. https://doi.org/10.1038/s41598-019-38491-0

Orford, N. R., Milnes, S., Simpson, N., Keely, G., Elderkin, T., Bone, A., Martin, P., Bellomo, R., Bailey, M., & Corke, C. (2019). Effect of communication skills training on outcomes in critically ill patients with life-limiting illness referred for intensive care management: a before-and-after study. BMJ Supportive & Palliative Care, 9(1), e21e21. https://doi.org/10.1136/bmjspcare-2016-001231

Orr, S. (2020). The Acceptability and Feasibility of Using Mortality Prediction Scores for Initiating End-of-Life Goals-of-Care Communication in the Adult Intensive Care Unit. Journal of Pain and Symptom Management, 59(1), 121129. https://doi.org/10.1016/j.jpainsymman.2019.09.0

Intervention to help substitute decision maker
Emiloju, O. E., Djibo, D. A. M., & Ford, J. G. (2020). Association Between the Timing of Goals-of-Care Discussion and Hospitalization Outcome’s in Patients With Metastatic Cancer. American Journal of Hospice and Palliative Medicine, 37(6), 433438. https://doi.org/10.1177/1049909119882891 Intervention to improve SDM decision making. 1) developing a decision aid to assist SDMs in setting goals of care for patients with traumatic brain injuries.
2) can also evaluate such tools and frameworks for their acceptability and feasibility to positively contribute to GOC discussions for patient, SDM, families, and HCP (Muehlschlegel et al., 2020; Quinn et al., 2017)

. 3)Finally, develop working groups with representatives from all stakeholders to evaluate and continuously improve implementation methods (Scheunemann et al., 2019). Scheunemann, L. P., Ernecoff, N. C., Buddadhumaruk, P., Carson, S. S., Hough, C. L., Curtis, J. R., Anderson, W. G., Steingrub, J., Lo, B., Matthay, M., Arnold, R. M., & White, D. B. (2019). Clinician-Family Communication About Patients Values and Preferences in Intensive Care Units. JAMA Internal Medicine, 179(5), 676. https://doi.org/10.1001/jamainternmed.2019.0027 Improve they have a comprehensive, collaborative empathetic approach that promotes open lines of communication between the health care providers and family (Wilson et al., 2015). Ahrend (2013) concluded that early, frequent, and scheduled discussions led by APNs improve support of patient and SDM establishing GOC.

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