TY - CHAP M1 - Book, Section TI - Providing Palliative Care and Withholding or Withdrawing Life-Sustaining Therapy A1 - Ford, Dee W. A1 - Curtis, J. Randall A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Approximately 20% of deaths in the United States are associated with or occur in an intensive care unit and a substantial majority of these deaths will have some aspect of intensive care treatment either withheld or withdrawn. High-quality care for patients dying in the ICU should incorporate the principles and practice of palliative care and therefore intensive care unit clinicians should familiarize themselves with basic aspects of palliative care.High-quality communication with critically ill patients and their family is an essential skill for ICU clinicians and one component of palliative care. Communication about end-of-life issues requires navigating cognitive, emotional, and ethical elements of decision making.The use of structured, patient- and family-centered approaches to end-of-life communication improves outcomes among family of deceased ICU patients.The provision of high-quality palliative care requires a multidisciplinary approach to effectively address physical, psychosocial, and spiritual suffering.An ideal model for palliative care in the ICU should include integrating principles of palliative care into routine ICU practice as well as the use of palliative care, ethics, and spiritual support teams for some patients and family members.Withdrawing or withholding life-sustaining therapy is widely accepted and common in the United States. This practice should adhere to the standards for quality medical care including appropriate documentation, attention to detail, an explicit plan for addressing patient, family, and clinician needs, and interdisciplinary implementation. An institutional protocol may help achieve these standards. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1107715589 ER -