In a 2004 study, researchers found that almost 20% of American deaths occur in a critical care setting or shortly after a critical care stay. Historically, the focus of critical care has been primarily on curative therapies, and death has been viewed as failure. Now, awareness of the need to integrate palliative care in critical care settings has increased. The challenges to providing quality end-of-life care include the hectic, fast-paced environment; different perceptions among team members regarding the patient’s goals of care as far as aggressive treatment versus seeking limited or no treatment; communication barriers between health care professionals, patients, and patients’ families; and a lack of research on improvements in the care of the dying in critical care settings.2–4  Often, because of these and other barriers, pain and other symptoms are inadequately relieved and patients’ goals of...

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