Study Identifies Surprising Priorities of Chronically Critically Ill Patients
To explore the expectations and goals of chronically critically ill patients, researchers interviewed 30 patients and 20 surrogates at a long-term acute care hospital.1
Daniela Lamas, MD, the study’s lead author, expected the patients would value life prolongation above all other goals. “However, I found that living as a long as possible no matter what was, in fact, the least important priority ranked for the majority of people surveyed,” says Lamas, a pulmonary and critical care fellow at Brigham and Women’s Hospital in Boston.
Life prolongation fell below cognitive effect and physical function for the majority of people surveyed. This held true for both patients and families.
Chronically critically ill patients are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting, notes Lamas. “The results of our work suggest to me that it is our ethical duty to try to understand our patients’ goals,” she says.
The findings indicate overly optimistic expectations about returning home, and unmet palliative care needs. This suggests the need for integration of palliative care within the long-term acute care hospital setting.
Lamas says clinicians have an ethical obligation to try to give patients the care that they want, and not to give care that patients do not want or care that does not move patients toward their goals.
“Long-term acute care hospitals, even if it is aggressive care for ill patients, can be appropriate if it aligns with a patient’s goals,” she says.
REFERENCE
- Lamas DJ, Owens RL, Nace RN, et al. Opening the door: The experience of chronic critical illness in a long-term acute care hospital. Crit Care Med. 2017; 45(4):e357-e362.
To explore the expectations and goals of chronically critically ill patients, researchers interviewed 30 patients and 20 surrogates at a long-term acute care hospital.
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