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Anaesth Intensive Care. 2017 Jul;45(4):466-468.

Does anyone ever expect to die?

Author information

1
Intensivist, Intensive Care Unit, Sir Charles Gairdner Hospital, Adjunct Researcher, Curtin University School of Public Health, Perth, Western Australia.
2
Post Doctoral Research Fellow, Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales.
3
Intensive Care Specialist, Intensive Care, University Hospital, Geelong, Victoria.
4
Senior Staff Specialist, Intensive Care, Nepean Hospital, Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales.
5
Director, Intensive Care Unit, Canberra Hospital, Associate Professor, ANU Medical School, Canberra, Australian Capital Territory.

Abstract

Patients who come to the intensive care unit are amongst the sickest patients in our hospitals. Patients can be admitted to the intensive care unit unexpectedly (following accidents or sudden onset of illness) or as unplanned but not necessarily truly 'unexpected' admissions. These patients often have significant underlying chronic health issues, including metastatic cancer, advanced cardiac, respiratory, renal, or hepatic failure, or frailty, with a high likelihood of death in the ensuing months. Using the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program, a prospective single-day observational study across 46 Australian hospitals in 2014 and 2015, we found that less than 9% of intensive care unit patients (51/577) had an advance directive available. From these results, we provide two suggestions to increase intensive care's understanding of patients' end-of-life wishes. First, systematically target 'high risk of dying' patient groups for goals of care conversations in the outpatient setting. Such groups include those where one would not be 'surprised' if they died within a year. Second, as a society, more conversations about end-of-life wishes are needed.

KEYWORDS:

palliative care, end-of-life issues, anaesthesia and intensive care

PMID:
28673216
[Indexed for MEDLINE]
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