IPACC Studies

Integrating Palliative and Critical Care (IPACC): An ICU Intervention to Improve End-of-life Care
Principal Investigator:  JR Curtis
Research Grant:  National Institute of Health / NINR, June 2003 to February 2008

The primary aim of this project was to evaluate the effectiveness of a multi-faceted intervention designed to improve the quality of dying in, or shortly after a stay in, the ICU using a randomized controlled study of 12 hospitals, controlling for clustering of patients within hospitals.  The intervention was evaluated with three patient-level outcome measures: the quality of dying, the quality of end-of-life care, and indicators of palliative care.  A secondary aim was to examine the variability in, and predictors of, the quality of dying and end-of-life care in community hospitals with the purpose of identifying the current quality of end-of-life care in non-academic settings and the factors associated with the quality of this care.  A final secondary aim was to evaluate the successful and unsuccessful components of the intervention and describe the institutional facilitators and barriers to the intervention’s implementation, with a focus on informing organizational interventions to improve care of the dying at other sites.

The IPACC Video (“Integrating Palliative and Critical Care — An Educational Video About Improving Palliative Care in the ICU “)  was available on the website of the National Institute of Nursing Research (NINR) at http://www.ninr.nih.gov/NewsAndInformation/PodCastMultimedia/.

clinicaltrials.gov: http://clinicaltrials.gov/ct2/show/NCT00685893

Promoting Palliative Care Excellence in the ICU
Principal Investigators:  JR Curtis, PD Treece
Research Grant:  Robert Wood Johnson Foundation, March 2003 to February 2006

This project was designed to implement and evaluate a multi-faceted, nurse-focused, quality improvement intervention to improve the quality of palliative care in the ICU.  The 5-component intervention included:  1) ICU clinician education on the principles and practice of palliative care; 2) multi-disciplinary unit champions to promote attitudinal change concerning palliative care; 3) academic detailing of ICU managers and clinicians to identify and address unit-specific barriers to improving palliative care; 4) feedback of quality improvement data to managers and clinicians; and 5) implementation of systems-level support to improve care, prevent compassion fatigue, and enhance sustainability.  Process measures included assessment of the intervention’s implementation and perceived usefulness.  Outcome measures included the quality of dying and death, satisfaction with care, and quality of care assessed by families, nurses, and chart review.  The overall goal was to demonstrate effectiveness of a generalizable intervention to improve palliative care in the ICU.

Publications from these studies include:

Lee JJ, Long AC, Curtis JR, Engelberg RA. The Influence of Race/Ethnicity and Education on Family Ratings of the Quality of Dying in the ICU. J Pain Symptom Manage. 2015 Sep 16. pii: S0885-3924(15)00455-8. [Epub ahead of print]

Khandelwal N, Engelberg RA, Benkeser DC, Coe NB, Curtis JR. End-of-Life Expenditure in the ICU and Perceived Quality of Dying. Chest. 2014 Dec 1;146(6):1594-603.

Long AC, Kross EK, Engelberg RA, Downey L, Nielsen EL, Back AL, Curtis JR. Quality of dying in the ICU: is it worse for patients admitted from the hospital ward compared to those admitted from the emergency department? Intensive Care Med. 2014 Nov;40(11):1688-97. Epub 2014 Aug 13.

Johnson JR, Engelberg RA, Nielsen EL, Kross EK, Smith NL, Hanada JC, Doll O’Mahoney SK, Curtis JR. The association of spiritual care providers’ activities with family members’ satisfaction with care after a death in the ICU. Crit Care Med. 2014 Sep;42(9):1991-2000.

Decato TW, Engelberg RA, Downey L, Nielsen EL, Treece PD, Back AL, Shannon SE, Kross EK, Curtis JR. Hospital Variation and Temporal Trends in Palliative and End-of-Life Care in the ICU. Crit Care Med. 2013 Jun;41(6):1405-11.

Kross EK, Nielsen EL, Curtis JR, Engelberg RA.  Survey burden for family members surveyed about end-of-life care in the intensive care unit. J Pain Symptom Manage. 2012 Nov;44(5):671-80. Epub 2012 Jul 3.

Osborn TR, Curtis JR, Nielsen EL, Back AL, Shannon SE, Engelberg RA.  Identifying elements of ICU care that families report as important but unsatisfactory: decision-making, control and ICU atmosphere. Chest. 2012; 142(5):1185–1192. Epub 2012 May 31.

Lewis-Newby M, Curtis JR, Martin DP, Engelberg RA. Measuring family satisfaction with care and quality of dying in the intensive care unit: does patient age matter? J Palliat Med. 2011 Dec;14(12):1284-90. Epub 2011 Nov 22.

Muni S, Engelberg RA, Treece PD, Dotolo D, Curtis JR.  The influence of race/ethnicity and socioeconomic status on end-of-life care in the intensive care unit. Chest. 2011 May;139(5):1025-33. Epub 2011 Feb 3.

Cooke CR, Hotchkin DL, Engelberg RA, Rubinson L, Curtis JR.  Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU.  Chest. 2010 Aug;138(2):289-97. Epub 2010 Apr 2.

Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE, Back AL, Rubenfeld GD, Engelberg RA.  Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial.  Am J Respir Crit Care Med. 2011 Feb 1;183(3):348-55. Epub 2010 Sep 10.

Curtis JR, Vincent JL.  Ethics and end-of-life care on the adult intensive care unit.  Lancet. 2010 Oct 16;376(9749):1347-53. Epub 2010 Oct 11.

Kross EK, Engelberg RA, Gries CJ, Nielsen EL, Zatzick D, Curtis JR.   ICU care associated with symptoms of depression and PTSD among family members of those who die in the ICU.  Chest. 2010. 2011 Apr;139(4):795-801. Epub 2010 Sep 9.

McCormick AJ, Curtis JR, Stowell-Weiss P, Toms C, Engelberg RA.  Improving social work in intensive care unit palliative care: results of a quality improvement intervention.  J Palliat Med. 2010 Mar;13(3):297-304.

Gries CJ, Engelberg RA, Kross EK, Zatzick D, Nielsen EL, Downey L, Curtis JR.  Predictors of symptoms of post-traumatic stress and depression in family members after patient death in the intensive care unit.   Chest. 2010 Feb;137(2):280-7. Epub 2009 Sep 17.

Kross EK, Engelberg RA, Shannon SE, Curtis JR.  Potential for response bias in family surveys about end-of-life care in the ICU.  Chest. 2009 Dec;136(6):1496-502. Epub 2009 Jul 17.

Gerstel E, Engelberg RA, Koepsell T, Curtis JR.  Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.  Am J Respir Crit Care Med. 2008 Oct 15;178(8):798-804.

Curtis JR, Treece PD, Nielsen EL, Downey L, Shannon SE, Braungardt T, Owens D, Steinberg KP, Engelberg RA. Integrating palliative and critical care: evaluation of a quality-improvement intervention.  Am J Respir Crit Care Med. 2008 Aug 1;178(3):269-75.

Glavan BJ, Engelberg RA, Downey L, Curtis JR.  Using the medical record to evaluate the quality of end-of-life care in the intensive care unit.  Crit Care Med. 2008 Apr;36(4):1138-46.

Curtis JR.  Caring for patients with critical illness and their families: the value of the integrated clinical team.  Respir Care. 2008 Apr;53(4):480-7.

Gries CJ, Curtis JR, Wall RJ, Engelberg RA.  Family member satisfaction with end-of-life decision-making in the ICU.  Chest. 2008 Mar;133(3):704-12. Epub 2008 Jan 15.

McCormick AJ, Engelberg R, Curtis JR.  Social workers in palliative care: assessing activities and barriers in the intensive care unit.  J Palliat Med. 2007 Aug;10(4):929-37.

Wall RJ, Curtis JR, Cooke CR, Engelberg RA.  Family satisfaction in the ICU: differences between families of survivors and non-survivors.  Chest. 2007 Nov;132(5):1425-33. Epub 2007 Jun 15.

Wall RJ, Engelberg RA, Gries CJ, Glavan B, Curtis JR.  Spiritual care of families in the intensive care unit.  Crit Care Med. 2007 Apr;35(4):1084-90.

Wall RJ, Engelberg RA, Downey L, Heyland DK, Curtis JR.  Refinement, scoring, and validation of the family satisfaction in the intensive care unit (FS-ICU) survey.  Crit Care Med. 2007; 35(1):271-9.

Treece PD, Engelberg RA, Shannon SE, Nielsen EL, Braungardt T, Rubenfeld GD, Steinberg KP, Curtis JR.  Integrating palliative and critical care: description of an intervention.  Crit Care Med. 2006 Nov;34(11 Suppl):S380-7.

Downey L, Engelberg RA, Shannon SE, Curtis JR. Measuring intensive care nurses’ perspectives on family-centered end-of-life care: evaluation of 3 questionnaires.  Am J Crit Care. 2006 Nov;15(6):568-79.