Does the ICU Have Policies in Place Regarding Advanced Care Planning and End-of-Life Directives?

Policies regarding advance care planning and end-of-life directives often vary among intensive care units in different healthcare institutions. Many patients with life-limiting illnesses or injuries do not have any documented advance directives while receiving care in the ICU, which can prompt conversations surrounding end-of-life preferences. However, in circumstances where an advance directive is not already in place, and the patient is already incapacitated due to injuries or life-limiting illnesses, the ICU team typically must contact the patient’s next-of-kin to make decisions regarding the patient’s care.

In an ideal situation in which the patient is not already incapacitated, the process of advance care planning would involve a discussion between the patient, their family, and the attending healthcare provider. This conversation would encompass preferences regarding interventions, life-sustaining treatments, and resuscitation, as well as any necessary documents that need to be included in the patient’s chart. These efforts ensure that the patient’s autonomy and capacity for decision-making are respected and upheld when decisions must be made regarding their care. Even so, studies have shown that physicians and nurses in the ICU sometimes struggle to facilitate end-of-life discussions with patients, which can suggest that this is not entirely appropriate within the scope of services provided in the ICU.

Although ICUs have policies in place to address advance care planning and end-of-life directives, it is essential to recognize that these components should be addressed proactively before an ICU admission is ever required. Since the purpose of intensive care is typically to provide life-saving interventions, it is not the most appropriate setting for discussing how aggressive patient care should be. Additionally, it can be challenging to effectively develop these plans due to the severity of the patient’s condition. Therefore, it is best to ensure that all preferences regarding end-of-life care are established well in advance of these decisions needing to be made in an emergency. 

Sources

“Intervention and efficacy of advance care planning for patients in intensive care units and their families: a scoping review protocol”. Nursing Open. https://pmc.ncbi.nlm.nih.gov/articles/PMC7877163/

“Advance directives in the trauma intensive care unit: Do they really matter?” International Journal of Critical Illness & Injury Science. https://pmc.ncbi.nlm.nih.gov/articles/PMC3249846/