Improving ICU Care For Older Adults Near the End of Life Through Time-limited Trials

At a Glance

In Wisconsin, one in three older adults is admitted to an intensive care unit (ICU) at or near the end of their life despite the vast majority expressing preferences to avoid such care. Patients in the ICU are often too sick to speak for themselves, and family members are asked to make these difficult decisions on the patient’s behalf. As a result of these challenges, surviving family members experience psychological distress after the patients’ ICU stay and ICU clinicians experience moral distress and burnout. Previous efforts to improve end-of-life ICU care have utilized time-limited trials which are agreements among patients, their surrogate decision makers, and clinicians to attempt life-sustaining treatment for a predefined period before evaluating whether the treatment is helping the patient. The specific objective of this project is to optimize the time-limited trial model to meet the needs of older adults admitted to the ICU and their surrogate decision makers. Successful completion of this project will determine whether the time-limited trial model of care leads to better end-of-life outcomes for patients, families, and clinicians.

The Challenge

In Wisconsin, one in three older adults is admitted to an intensive care unit (ICU) at or near the end of their life despite the vast majority expressing preferences to avoid such care. One of the challenges in aligning end-of-life healthcare with older adults’ preferences is that recognizing when the end of life is near has become increasingly difficult as medical technology and treatments become increasingly capable of extending life. Many older adults facing a life threatening medical condition have two competing priorities: one, to live as long as possible and, two, to avoid invasive or prolonged treatments like life support if the chance of recovery is low. Patients in the ICU are often too sick to speak for themselves, and family members are asked to make these difficult decisions on the patient’s behalf. As a result of these challenges, surviving family members experience psychological distress after the patients’ ICU stay and ICU clinicians experience moral distress and burnout.

Previous efforts to improve end-of-life ICU care have utilized time-limited trials which are agreements among patients, their surrogate decision makers, and clinicians to attempt life-sustaining treatment for a predefined period before evaluating whether the treatment is helping the patient.

Project Goals

The specific objective of this project is to optimize the time-limited trial model to meet the needs of older adults admitted to the ICU and their surrogate decision makers. The researchers will address this objective through two specific aims. First, the team will design a graphic aid to support ICU clinicians and surrogates of critically ill older adults when planning a time-limited trial. Second, the team will evaluate the perspectives on the time-limited trail care model using focus groups made up of older adults with life-limiting illness and family caregivers.