Periodic Reporting for period 1 - EPIC (Enhancing palliative care in ICU)
Période du rapport: 2024-01-01 au 2025-06-30
EPIC - Enhancing palliative care in ICU
The context of EPIC is the intensive care setting. We focus on patients in intensive care units (ICUs) who are in need of palliative care. Many of these patients have severe critical illnesses, are often elderly, and experience life-threatening complications. It is estimated that 20% to 60% of ICU patients would benefit from palliative care. However, palliative care is not well integrated within European ICUs.
Palliative care means relieving distressing symptoms, communicating effectively with patients and families and enhancing joint decision-making. It means a timely goal shift from primarily life-prolonging treatment towards relief of suffering and requires a change of culture.
This problem must be tackled on several levels. Staff often lack support and mentorship to recognise supportive care needs. There is a lack of access to palliative care experts in Europe where many hospitals and areas are underserved. Lastly, there is widespread misunderstanding of palliative care in ICU: many professionals, patients and families believe palliative care means letting the patient die and thus frequently refuse to consider it.
EPIC has the overall goal to improve palliative care for critically ill and dying non-cancer patients and their families across European ICUs. The main objective is to implement and evaluate a recommended practice model which supports ICU clinicians through tele-counselling, staff education and bedside tools.
The pathway to impact includes:
- A multicentre interventional clinical trial with a randomised stepped wedge design
- A complex intervention to support ICU clinicians, consisting of a trigger checklist to identify ICU patients and families with palliative care needs, standardised tele-palliative counselling by trained experts, a blended learning program for ICU clinicians (nurses and physicians) and a factsheet for ICU clinicians.
- The establishment of a European patient and family advisory group to involve the public
- Assessment of citizens’ perception about tele-palliative care, leading to the development of ethical recommendations for tele-palliative care
- Mapping and considering facilitators and barriers for palliative and end-of-life care in ICU
- Development of a preference-sensitive patient decision aid for future use
- A sustainability plan, integrating outcomes and insights generated from the project into a refined and open access version of the EPIC model and training tools.
The results are expected to tackle the problems because EPIC is the first prospective study to generate evidence on the effectiveness and cost effectiveness of a palliative care intervention for all stakeholders in the European setting. Added value is generated by
• implementation of the model into everyday practice across varying types of ICU and countries
• using accepted low-tech methods of telemedicine where telerobots are not available
• best practice training of experts to enable a high standard of palliative care counselling
• tailored training of ICU clinicians and counselling experts to increase awareness and skills
• ethical orientation based on citizen perspective to avoid pitfalls and increase the potential benefits of future tele-palliative activities
• fostering patient-provider interaction through a dedicated European patient and family advisory group with national nodes
The EPIC project is pragmatic and scalable to other intensive care settings, regions and countries. Telemedicine offers a sustainable solution to staff shortage and lack of access, including access to high-quality care for hospitals which otherwise cannot afford the staff and the infrastructure. Tele-palliative care can contribute to affordable and high-quality care to meet the demand of Europe’s ageing population.
The context of EPIC is the intensive care setting. We focus on patients in intensive care units (ICUs) who are in need of palliative care. Many of these patients have severe critical illnesses, are often elderly, and experience life-threatening complications. It is estimated that 20% to 60% of ICU patients would benefit from palliative care. However, palliative care is not well integrated within European ICUs.
Palliative care means relieving distressing symptoms, communicating effectively with patients and families and enhancing joint decision-making. It means a timely goal shift from primarily life-prolonging treatment towards relief of suffering and requires a change of culture.
This problem must be tackled on several levels. Staff often lack support and mentorship to recognise supportive care needs. There is a lack of access to palliative care experts in Europe where many hospitals and areas are underserved. Lastly, there is widespread misunderstanding of palliative care in ICU: many professionals, patients and families believe palliative care means letting the patient die and thus frequently refuse to consider it.
EPIC has the overall goal to improve palliative care for critically ill and dying non-cancer patients and their families across European ICUs. The main objective is to implement and evaluate a recommended practice model which supports ICU clinicians through tele-counselling, staff education and bedside tools.
The pathway to impact includes:
- A multicentre interventional clinical trial with a randomised stepped wedge design
- A complex intervention to support ICU clinicians, consisting of a trigger checklist to identify ICU patients and families with palliative care needs, standardised tele-palliative counselling by trained experts, a blended learning program for ICU clinicians (nurses and physicians) and a factsheet for ICU clinicians.
- The establishment of a European patient and family advisory group to involve the public
- Assessment of citizens’ perception about tele-palliative care, leading to the development of ethical recommendations for tele-palliative care
- Mapping and considering facilitators and barriers for palliative and end-of-life care in ICU
- Development of a preference-sensitive patient decision aid for future use
- A sustainability plan, integrating outcomes and insights generated from the project into a refined and open access version of the EPIC model and training tools.
The results are expected to tackle the problems because EPIC is the first prospective study to generate evidence on the effectiveness and cost effectiveness of a palliative care intervention for all stakeholders in the European setting. Added value is generated by
• implementation of the model into everyday practice across varying types of ICU and countries
• using accepted low-tech methods of telemedicine where telerobots are not available
• best practice training of experts to enable a high standard of palliative care counselling
• tailored training of ICU clinicians and counselling experts to increase awareness and skills
• ethical orientation based on citizen perspective to avoid pitfalls and increase the potential benefits of future tele-palliative activities
• fostering patient-provider interaction through a dedicated European patient and family advisory group with national nodes
The EPIC project is pragmatic and scalable to other intensive care settings, regions and countries. Telemedicine offers a sustainable solution to staff shortage and lack of access, including access to high-quality care for hospitals which otherwise cannot afford the staff and the infrastructure. Tele-palliative care can contribute to affordable and high-quality care to meet the demand of Europe’s ageing population.
In the first 18 months, the consortium performed all activities as planned, including
- Preparation and set-up of the EPIC stepped-wedge, randomised multicentre interventional clinical trial (RCT) in 27 ICUs across 7 centres in 5 European countries
- initiating the study in all clinical centres
- establishing an infrastructure for monitoring progress and managing risks
- developing and implementing the intervention measures
In addition:
- Conduct and evaluation of a European survey among ICU physicians and nurses to assess their perception of palliative practice and the legal framework for end-of-life care
- Establishing and coordinating an international patient and family advisory group
- Identification of the ethical concepts and arguments that are discussed in the literature on the use of tele-palliative care
- Preparation and set-up of the EPIC stepped-wedge, randomised multicentre interventional clinical trial (RCT) in 27 ICUs across 7 centres in 5 European countries
- initiating the study in all clinical centres
- establishing an infrastructure for monitoring progress and managing risks
- developing and implementing the intervention measures
In addition:
- Conduct and evaluation of a European survey among ICU physicians and nurses to assess their perception of palliative practice and the legal framework for end-of-life care
- Establishing and coordinating an international patient and family advisory group
- Identification of the ethical concepts and arguments that are discussed in the literature on the use of tele-palliative care
EPIC redefines what “state-of-the-art” means in critical care. EPIC reimagines excellence in intensive care by shifting the focus from purely technological interventions to what truly matters to patients and families: relief of suffering, meaningful communication, and preservation of dignity.
EPIC is embedding palliative care principles into everyday ICU practice—integrating them into workflows, clinical training, and decision-making processes.
The project introduces scalable, low-tech innovations—such as tele-counselling and bedside tools—that are accessible even in resource-constrained ICUs. Through education, co-creation with patients and families, and ethical reflection grounded in real-life experiences, EPIC challenges the notion that excellence lies in delivering the most aggressive treatment, proposing instead a model of care that is compassionate, appropriate, and aligned with what patients value most.
Beside the ongoing clinical study, additional activities warrant specific mentioning:
- All interventional measures in the first ICUs that crossed over into the intervention period to date are extending daily practice to integrate palliative care; thereby aiming to change the institutional culture
- ICU clinician education extends beyond state of the art because it addresses barriers (including lack of awareness of benefits and need, difficulty of messaging palliative care, when to call for consultation), thereby aiming to sustainably change behaviour and increase skills
- The establishment of a European patient and family advisory group is a novel activity in the field, aiming to enhance patient-provider interaction.
EPIC is embedding palliative care principles into everyday ICU practice—integrating them into workflows, clinical training, and decision-making processes.
The project introduces scalable, low-tech innovations—such as tele-counselling and bedside tools—that are accessible even in resource-constrained ICUs. Through education, co-creation with patients and families, and ethical reflection grounded in real-life experiences, EPIC challenges the notion that excellence lies in delivering the most aggressive treatment, proposing instead a model of care that is compassionate, appropriate, and aligned with what patients value most.
Beside the ongoing clinical study, additional activities warrant specific mentioning:
- All interventional measures in the first ICUs that crossed over into the intervention period to date are extending daily practice to integrate palliative care; thereby aiming to change the institutional culture
- ICU clinician education extends beyond state of the art because it addresses barriers (including lack of awareness of benefits and need, difficulty of messaging palliative care, when to call for consultation), thereby aiming to sustainably change behaviour and increase skills
- The establishment of a European patient and family advisory group is a novel activity in the field, aiming to enhance patient-provider interaction.