Why End-of-Life Discussion Matters: A Systematic Literature Review

End-of-life (EOL) discussions are a challenging yet vital topic of conversation in intensive care units (ICU) between healthcare providers, patients, and their families. There is great disparity in where, when, and how EOL discussions take place, but the consequences of neglecting their importance can be devastating physically, psychologically, and financially for all parties involved. Multiple inadequacies in the EOL discussion process have not only contributed to a personal and societal financial burden but an unacceptable quality of death for many ICU patients. A literature review was performed to determine what practice and policy changes could be made to improve EOL discussion between healthcare providers and their patients. A total of seven articles met criteria. Main findings revealed deficits in areas including provider education, congruence of care, and clear communication. Advance care directives, prognostic estimators, and early and structured communication played a role in some improvement in these inadequacies. These findings have the capability of guiding us toward improved EOL practices including shared decision-making with patients and their loved ones, early discussion and documentation of wishes, and the ability to advocate for formal training in EOL care for all healthcare providers. Further research is necessary to determine how these techniques would affect ICU resource utilization and length of stay