Project name: Enhancing palliative care in ICU – EPIC

Project start date: 1. 1. 2024
Project completion date: 31. 12. 2028
Project Budget: a total of EUR 6,668,255 (of which EUR 468,750 for VFN)
Project guarantor: Clinic of palliative medicine, doc. MD MgA. Kateřina Rusinová, Ph.D.
Project Registration Number: 101137221

Project brief:

The project was supported by the EU Horizon EUROPE program and will be implemented by an international consortium including 16 public and private sector entities.

The project coordinator is Charite – Universitäts Medizin Berlin, Germany, VFN is one of the partners.

The EPIC project aims to sustainably improve palliative care for critically ill patients and their families in the ICU. An interdisciplinary international consortium is developing a new harmonized model for providing new palliative care using telemedicine. The project is the first European ICU palliative care intervention study that uses a systems approach with proactive patient identification, a checklist and blended learning tailored to the specific needs of ICU clinical staff.

Approximately 10% of all deaths in the population die after admission to an intensive care unit (ICU). These patients often suffer from distressing symptoms and may receive intensive life-prolonging treatments that they would not choose if given the choice. Their family members often experience prolonged stress, and many ICU physicians and nurses experience the burden of being perceived to provide inadequate and potentially ineffective treatment.

The effectiveness of the new model is evaluated through a randomized trial with a phased intervention in 7 clinical centers from 5 European countries, 23 multidisciplinary ICUs and enrolling 2001 patients. The primary outcome is a reduction in ICU length of stay with a reduction in suffering. Cost impacts and cost-effectiveness will be assessed from different perspectives. An evidence-based tool for patient decision-making (decision-aid) is being developed. Further research will help deepen our understanding of barriers and facilitators and provide ethical guidelines for the use of telepalliative care. EPIC's vision is to contribute to a shift in thinking from a narrow focus on life extension to a more holistic view of care. As part of the project, we will be working closely with a group of patients and family members to enable them to get involved and help raise awareness of palliative care from the very beginning. Telemedicine offers a low-cost solution to spread the model to all regions in Europe and opens new avenues for patient-centered care.

Abstract in English:

About 10% of all decedents in the population die after admission to an intensive care unit (ICU). These patients often have distressing symptoms and may receive more intense life-prolonging treatment than they would have chosen, their family members often experience lasting distress from the experience and many ICU physicians and nurses are burdened by their perception of potentially non-beneficial care.

The EPIC project aims to sustainably improve palliative care for critically ill patients and their families in the ICU. An interdisciplinary consortium collaborates to provide a novel harmonized palliative care practice model using telemedicine. The project is the first European interventional study on palliative care in the ICU, using a systems-based approach with proactive patient identification, checklist and blended learning targeted to specific requirements of ICU clinicians.

Effectiveness of the new model is assessed through a stepped wedge randomized trial with 7 clinical centers from 5 European countries, 23 multi-disciplinary ICUs and enrollment of 2001 patients. Primary outcome is a reduction in ICU stay to relieve suffering. Cost implications and cost effectiveness will be assessed from different perspectives. An evidence-based patient decision aid for critically ill patients is developed. Additional outcomes serve to deepen our understanding of barriers and facilitators and provide ethical recommendations for the use of telepalliative care in civic society. The vision of EPIC is to contribute to a mind shift from a narrow focus on prolonging life towards more holistic care. A European patient and family advisory group is implemented to engage patients and family members from the start and co-create open-access information to increase acceptance of palliative care. Telemedicine offers a low-cost solution to spread the model to all regions in Europe and open new avenues for patient-centered care.