Primary palliative care in the ICU.

Despite the best efforts of modern health care and critical care providers, many patients in the intensive care unit (ICU) will still die each year. The need for palliative care services in the ICU is common. Although specialty palliative care services provide excellent care and are a tremendous resource, every critical care provider should be able to provide the basics of palliative care themselves through the model of primary palliative care. Although it may be uncomfortable for the critical care provider at first, providing palliative care to our ICU patients can be a very rewarding experience. In this article, I discuss best practices for handling difficult conversations with patients and their families, helping patients and families make difficult decisions regarding the goals of care, and managing symptoms at the end of life.