[Changes in treatment goals and palliative care in the intensive care unit-when and how?]

Abstract

Intensive care for patients with hemato-oncological diseases is a complex interplay between life-prolonging therapy and palliative care. Especially in cases with a limited prognosis, early clarification of treatment goals and transition to palliative-oriented measures become increasingly important. When is a change in treatment goals appropriate in the intensive care unit, and how can patient-centered, suffering-oriented care be implemented in a structured way? The concept of a time-limited trial (TLT) offers a structured framework to allow a limited period of intensive care treatment with clearly defined success criteria in cases of uncertain prognosis. Even more important is to make anticipatory decisions for acute situations through early communication with patients and their families. This is illustrated using the example of discussions around resuscitation attempts. The integration of palliative care, ethics consultation, and interprofessional teams contributes to avoiding overtreatment and to safeguarding patient autonomy.