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Journal of Korean Neurosurgical Society > Epub ahead of print

doi: https://doi.org/10.3340/jkns.2024.0065    [Epub ahead of print]
Integration of Palliative Care in Neurosurgical Critical Care : Insights from a Single-Center Perspective
Nam Hee Kim1 , Yejin Kim1 , Se Yeon Kim1 , Hyoung Suk Han1 , Hye Yoon Park1,2 , Eun Jin Ha3 , Shin Hye Yoo1
1Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
2Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
3Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
Correspondence  Eun Jin Ha ,Tel: +82-2-2072-3639, Fax: +82-2-744-8459, Email: 65932@snuh.org
Shin Hye Yoo ,Tel: +82-2-2072-1589, Fax: +82-2-2072-0754, Email: ifi1024@snu.ac.kr
Received: March 15, 2024; Revised: August 22, 2024   Accepted: September 21, 2024.  Published online: September 24, 2024.
*Nam Hee Kim and Yejin Kim contributed equally to this work.
ABSTRACT
Objective
: Palliative care is a specialized approach designed to enhance the quality of life for both patients and their families, offering patient-centered care through comprehensive assessment and care planning. However, the integration of palliative care within neurocritical care settings has been relatively understudied. This descriptive study aims to identify the characteristics, palliative care needs, and outcomes of patients referred to palliative care services during admission to the neurosurgical intensive care unit (NS-ICU).
Methods
: A retrospective analysis of adults admitted to the NS-ICU at a referral hospital between December 2019 and December 2021 was conducted. The study focused on those referred to the inpatient palliative care team with diagnoses of non-traumatic brain hemorrhage, traumatic brain injury, or brain neoplasm. Excluded were patients who died before palliative care consultation or lacked sufficient information. The investigation assessed demographic and clinical characteristics at consultation, along with post-consultation hospital outcomes derived from medical records and interview notes.
Results
: In this study involving 38 enrolled patients, the median age was 65, with 42.1% females. The most prevalent diagnosis was nontraumatic brain hemorrhage (47.4%). Reasons for palliative care consultation included psychosocial support (95%), goal-of-care discussions (68%), decision-making support (50%), and communication facilitation (39%). The median time from NS-ICU admission to consultation was 3.5 days (interquartile range, 1–8 days), and all interviews involved family members. Key decision topics encompassed mechanical ventilation (23.7%) and tracheostomy (21.1%). Patient preferences for life-sustaining treatment could be estimated in only 47.4% of cases, often resulting in treatment disagreement. Among the 38 patients, 26 (68.4%) died during admission. Before the consultation, full code status, partial code status, and comfort care alone were reported as 32%, 66%, and 2%, respectively; post-consultation, these figures shifted to 11%, 42%, and 47%, respectively.
Conclusion
: Palliative care was predominantly sought for psychosocial support and discussions concerning goals of care. Despite challenges in ascertaining patient treatment preferences, palliative care consultations proved invaluable in aiding family members and facilitating treatment decision-making. Our study suggests the potential integration of palliative care within neuro-critical care, contributing to a heightened utilization of comfort care at the end-of-life.
Key Words: Critical care · Life support care · Palliative care · Patient-centered care · Life-sustaining treatment
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