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

Iben Strøm Darfelt^{1

2}, Mette Asbjoern Neergaard^{2

3}, Pål Klepstad^{4

5}, Johanna Hästbacka⁶, Gunnar Thorarensen⁷, Andrew Campbell Robertson⁸, Åse Valsø^{9

10}, Hanne Irene Jensen^{11

12}, Mikael Segerlantz^{13

14

15}, Juho T Lehto¹⁶, Johan Malmgren¹⁷, Morten Hylander Møller^{18

19}, Anne Højager Nielsen^{1

2}

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark.
² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
³ Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
⁵ Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
⁶ Department of Anaesthesia and Intensive Care, Tampere University Hospital, Wellbeing Services County of Pirkanmaa and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
⁷ Department of Anaesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland.
⁸ Anaesthesia and Intensive Care, Baerum Hospital, Baerum, Norway.
⁹ Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁰ Lovisenberg Diaconal University College, Oslo, Norway.
¹¹ Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
¹² Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹³ Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden.
¹⁴ Institute for Palliative Care, Primary Health Care Skåne, Lund, Sweden.
¹⁵ Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden.
¹⁶ Palliative Care Centre, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
¹⁷ Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
¹⁹ Dept. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

PMID: 40066825
PMCID: PMC11894781
DOI: 10.1111/aas.70015

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

Iben Strøm Darfelt et al. Acta Anaesthesiol Scand. 2025 Apr.

. 2025 Apr;69(4):e70015.

doi: 10.1111/aas.70015.

Authors

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark.
² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
³ Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Anaesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
⁵ Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
⁶ Department of Anaesthesia and Intensive Care, Tampere University Hospital, Wellbeing Services County of Pirkanmaa and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
⁷ Department of Anaesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland.
⁸ Anaesthesia and Intensive Care, Baerum Hospital, Baerum, Norway.
⁹ Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁰ Lovisenberg Diaconal University College, Oslo, Norway.
¹¹ Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.
¹² Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
¹³ Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Institute for Palliative Care, Faculty of Medicine, Lund University, Lund, Sweden.
¹⁴ Institute for Palliative Care, Primary Health Care Skåne, Lund, Sweden.
¹⁵ Department of Palliative Care and Advanced Home Health Care, Primary Health Care Skåne, Lund, Sweden.
¹⁶ Palliative Care Centre, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
¹⁷ Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
¹⁸ Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
¹⁹ Dept. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

PMID: 40066825
PMCID: PMC11894781
DOI: 10.1111/aas.70015

Abstract

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.

Keywords: Delphi technique; clinical practice guidelines; end‐of‐life care; intensive care unit; palliative care.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

**FIGURE 1**
Characteristics and tasks for advisory board and respondents.

**FIGURE 2**
Flowchart of Delphi process.

See this image and copyright information in PMC

References

1. Brown CE, Benoit DD, Curtis JR. Focus on palliative care in the ICU. Intensive Care Med. 2017;43(12):1898‐1900. - PubMed
1. Catalisano G, Ippolito M, Marino C, Giarratano A, Cortegiani A. Palliative care principles and anesthesiology clinical practice: current perspectives. J Multidiscip Healthc. 2021;14:2719‐2730. doi:10.2147/JMDH.S240563 - DOI - PMC - PubMed
1. Schuttengruber G, Grossschadl F, Lohrmann C. A consensus definition of end of life from an international and interdisciplinary perspective: a Delphi panel study. J Palliat Med. 2022;25(11):1677‐1685. - PubMed
1. Clarke EB, Curtis JR, Luce JM, et al. Quality indicators for end‐of‐life care in the intensive care unit. Crit Care Med. 2003;31(9):2255‐2262. - PubMed
1. Sprung CL, Cohen SL, Sjokvist P, et al. End‐of‐life practices in European intensive care units: the Ethicus study. JAMA. 2003;290(6):790‐797. doi:10.1001/jama.290.6.790 - DOI - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical