01738nas a2200229   4500000000100000008004100001653001100042653002400053653002500077653001000102653001800112100001400130700001500144700001200159700001300171700001500184245003600199300001200235490000700247520124000254022001401494       2017                            d10aHumans10aProspective Studies10aIntensive Care Units10aDeath10aTerminal Care1 aSeppelt I1 aAnstey Mhr1 aWatts N1 aOrford N1 aMitchell I00aDoes anyone ever expect to die?  a466-4680 v453 a<p>
Patients who come to the intensive care unit are amongst the sickest patients in our hospitals. Patients can be admitted to the intensive care unit unexpectedly (following accidents or sudden onset of illness) or as unplanned but not necessarily truly 'unexpected' admissions. These patients often have significant underlying chronic health issues, including metastatic cancer, advanced cardiac, respiratory, renal, or hepatic failure, or frailty, with a high likelihood of death in the ensuing months. Using the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program, a prospective single-day observational study across 46 Australian hospitals in 2014 and 2015, we found that less than 9% of intensive care unit patients (51/577) had an advance directive available. From these results, we provide two suggestions to increase intensive care's understanding of patients' end-of-life wishes. First, systematically target 'high risk of dying' patient groups for goals of care conversations in the outpatient setting. Such groups include those where one would not be 'surprised' if they died within a year. Second, as a society, more conversations about end-of-life wishes are needed.
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