Consensus statements on end-of-life care in ICU – A Scandinavian multidisciplinary Delphi study

Background: End-of-life care in the Intensive Care Unit (ICU) is complex, requiring a balance of ethical, cultural and medical considerations while ensuring comfort and dignity for critically ill patients and their families. Aim: We aimed to develop a set of core domains for end-of-life care at Scandinavian ICUs along with corresponding consensus statements from patients, families and multidisciplinary experts. Methods: In a three-round Delphi study, a multidisciplinary advisory board from Norway, Sweden, Finland, Iceland and Denmark, including ICU physicians, ICU nurses, palliative care specialists and a former ICU patient and family, developed potential end-of-life care domains of interest. Specialists with special competence/interest in end-of-life care and clinicians in all five countries were invited to rank these domains according to their importance and provide recommendations within each domain. The advisory board rephrased the recommendations into statements, which were sent out in the second round for participants to rate based on their level of agreement. Statements that did not achieve consensus in the second round were rephrased and redistributed in the third round. Results: After the third Delphi round, 59 statements across 10 domains reached consensus. The domains were: 1. Communication at ICU admission, 2. Withholding and withdrawal of therapy and end-of-life care decisions in the ICU, 3. Meeting religious and spiritual needs and the needs of vulnerable patients in the ICU, 4. Extubation and termination of mechanical ventilation at the end of life in the ICU, 5. Management and monitoring of symptoms at the end of life in the ICU, 6. Continuous sedation at the end of life in the ICU, 7. Indicators for specialist palliative care consultations in the ICU, 8. Patient transfers from the ICU at the end of life, 9. Bereavement care and 10. Debriefing in the ICU following a patient's death. Discussion: We developed core domains and consensus statements aiming at optimising end-of-life care that considers cultural and ethical nuances. The domains may help to shape end-of-life care guidelines in Scandinavian ICUs.