• Jozef Kesecioglu, Katerina Rusinova, Daniela Alampi, Yaseen M Arabi, Julie Benbenishty, Dominique Benoit, Carole Boulanger, Maurizio Cecconi, Christopher Cox, Marjel van Dam, Diederik van Dijk, James Downar, Nikolas Efstathiou, Ruth Endacott, Alessandro Galazzi, Fiona van Gelder, Rik T Gerritsen, Armand Girbes, Laura Hawyrluck, Margaret Herridge, Jan Hudec, Nancy Kentish-Barnes, Monika Kerckhoffs, Jos M Latour, Jan Malaska, Annachiara Marra, Stephanie Meddick-Dyson, Spyridon Mentzelopoulos, Mervyn Mer, Victoria Metaxa, Andrej Michalsen, Rajesh Mishra, Giovanni Mistraletti, Margo van Mol, Rui Moreno, Judith Nelson, SuñerAndrea OrtizAOHospital Arnau de Vilanova-Lliria, Valencia, Spain.Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain., Natalie Pattison, Tereza Prokopova, Kathleen Puntillo, Kathryn Puxty, Samah Al Qahtani, Lukas Radbruch, Emilio Rodriguez-Ruiz, Ron Sabar, Stefan J Schaller, Shahla Siddiqui, Charles L Sprung, Michele Umbrello, Marco Vergano, Massimo Zambon, Marieke Zegers, Michael Darmon, and Elie Azoulay.
• Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. j.kesecioglu@umcutrecht.nl.
• Intensive Care Med. 2024 Oct 3.

AbstractThe European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.© 2024. The Author(s).

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