Trends in Palliative Care Consultations in Critically Ill Patient Populations, 2013-2019

Abstract

ContextCritically ill patients have important palliative care (PC) needs in the intensive care unit (ICU), but specialty PC is often underutilized. ObjectiveTo evaluate changes in utilization and reasons for PC consultation over time. MethodsData from a national multi-site network of inpatient PC visits were used to identify patients age ≥18 years admitted to an ICU between 2013 and 2019. Year of ICU admission was the exposure. Primary diagnosis and reason for referral were identified by standardized process measures within the dataset at the time of referral. Trends in primary diagnosis and reason for referral were modeled as a function of year of ICU admission. ResultsAcross 39,515 ICU patients seen by a PC team, overall numbers of consultations from the ICU increased each year. Referrals for patients with cancer decreased from 17.6% (95% CI 13.7%–21.5%) to 14.3% (95% CI 13.2%–14.7%) and for patients with cardiovascular disease increased from 16.8% in (95% CI 16.8%–16.9%) to 18.8% (95% CI 18.8%–18.9%). Reasons for referrals were primarily for goals of care and advance care planning and increased from 74.0% (95% CI 70.0%–78.0%) in 2013 to 80.0% (95% CI 79.4%–80.0%) in 2019 (P < 0.0001 for all trends). ConclusionPC referrals in ICU patients with cancer are decreasing, while those for cardiovascular disease are increasing. Reasons for referrals in the ICU are commonly for goals of care; other reasons, like pain control are uncommon. Early goals of care conversations and further training in advance care planning should be emphasized in the ICU setting.