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19 End of Life in Critical Care; Time for More Training?
  1. Conal Corr,
  2. Stuart Edwardson and
  3. Sophie Henderson
  1. Belfast Health and Social Care Trust, Bath NHS Foundation Trust, NHS Fife


Introduction It is estimated that 15–20% of patients admitted to critical care will die during their admission. The Faculty of Intensive Care Medicine state that critical care teams should be aware of the importance of a good death. Prognostic uncertainty and increasing complexity of ICU patients are some of the barriers to a good death. The curriculum in Palliative Medicine newly includes dual training with General Internal Medicine. Supporting early palliative care involvement across a wide range of patient groups is now recommended.

Methods A cross-specialty focus group met to discuss curriculum requirements in both training programmes. This was to identify opportunities for enhanced training and collaborative learning. Literature was also consulted to gather evidence that each of these specialities can gain invaluable experience from the other. A survey of intensive care trainees in the UK was used to ascertain if experience in the field of palliative medicine would be useful in a career in intensive care.

Results Curriculum review identified key learning points between specialties; understanding of complex pharmacology of symptom management and navigating ethically challenging situations. Review of evidence identified learning needs for those caring for patients who die in ICU; hydration and nutrition at end of life and anticipatory prescribing. Seventy-five ICM trainees responded to the survey. Findings included that 61 of 75 respondents (81%) agreed or strongly agreed that observed consultations with a palliative care specialist would be beneficial. 41 of 75 respondents (54%) did not feel confident in decision making regarding hydration/nutrition at end of life.

Conclusion Collaborative learning between palliative medicine and intensive care requires further exploration. There is a desire from intensive care trainees to gain experience from palliative physicians to optimize care for patients who die in intensive care. This experience might take the form of a short placement or formal teaching.

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