What's new in palliative care

The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

GENERAL PRINCIPLES OF PALLIATIVE CARE

Society of Critical Care Medicine guidelines for family/caregivers in the intensive care unit (March 2025)

The Society of Critical Care Medicine (SCCM) issued updated guidelines on family/caregiver support in the intensive care unit (ICU) [1]. Using a growing body of evidence, the SCCM issued a strong recommendation for liberal caregiver/family presence in the ICU. This includes family/caregiver presence on rounds and resuscitation, participation in care as well as the provision of dedicated space, ICU diaries, education tools, and psychological, spiritual, and bereavement support. The SCCM also made a conditional recommendation for communication support for both family/caregivers and clinicians. We agree with the recommendations. (See "Post-intensive care syndrome (PICS): Treatment and prognosis", section on 'Post-intensive care syndrome-family'.)

Trial of emergency clinician palliative care educational program (January 2025)

Emergency department (ED) patients with chronic, severe, or life-threatening conditions may benefit from palliative interventions, but the benefit of such care provided by ED clinicians is unclear. In a cluster randomized trial conducted in almost 30 EDs and including 99,000 visits, a palliative care educational intervention for emergency physicians, nurses, and advanced practice providers resulted in fewer hospital admissions in the post-intervention period (61 versus 64 percent), but the findings did not achieve statistical significance [2]. While ED-based palliative care interventions may have the potential to accomplish important goals, the optimal approach is still unknown. (See "Palliative care for adults in the ED: Concepts, presenting complaints, and symptom management", section on 'Why the integration of palliative care in the ED is important'.)

SELECTED END-STAGE CONDITIONS

Geriatric care management in community-dwelling patients with dementia (March 2025)

Geriatric care management can assist patients with dementia and their caregivers in accessing support services and provide guidance in patient care. In one trial of 201 patients with moderate to severe dementia and their caregivers, an intervention consisting of monthly calls from a trained nurse or social worker resulted in fewer combined emergency department and hospitalization events over 24 months (1.1 versus 2.4 mean events/patient in the intervention versus usual care group), but did not improve patient neuropsychiatric symptom severity or caregiver distress [3]. While care management has the potential to improve patient outcomes, the best model for such care is not clear. (See "Management of the patient with dementia", section on 'Care management'.)