The EPIC (Enhancing Palliative Care in the ICU) project is a Europe-wide initiative aimed at integrating palliative care into ICUs to improve the quality of life for critically ill patients and their families. Launched in January 2024, the project brings together leading institutions from across Europe and is now in its second year. Details about the EPIC project were shared at the ESAIC Hub at #EA25.
In the EPIC model, ICU clinicians deliver primary palliative care, including symptom management, communication, and family support. Specialist palliative care teams are available to consult in more complex situations.
To ensure effective collaboration, ICU teams and palliative care experts receive tailored education designed to foster mutual understanding of each other’s roles, cultures, and clinical approaches. EPIC has developed targeted educational programmes, specialist training, and a comprehensive trigger list to guide implementation.
The EPIC clinical study began in October 2024 and will run for approximately three years. It employs a controlled, cluster-randomised, non-blinded, crossover design with a stepped-wedge methodology. Over 25 ICUs in five European countries, including Germany, Greece, Czech Republic, Italy, and Israel, are participating in the study.
Eligible participants include all consecutive adult non-cancer patients treated in the ICU for at least 72 hours, where the treating physician identifies a potential benefit from specialised palliative care. Criteria may include ongoing conflict about ICU treatment, discussions about therapy limitations, or clinical judgment of likely benefit from a palliative care consultation. Relatives of enrolled patients are also invited to take part. Written informed consent is obtained from all participants or their legal surrogates, as well as from relatives.
All participating ICUs begin in the observation phase, where standard care is provided without telemedical PC consultations. Each ICU transitions to the intervention phase at a randomly assigned time. During the crossover month, ICU staff receive training, the trigger list is introduced, and palliative care consultants undergo specific preparation. During the intervention period, palliative care consultations are provided via telemedicine. Follow-up interviews with patients and relatives take place three months after ICU discharge.
Intervention Measures
1. Education for ICU Staff
ICU physicians and nurses receive training to strengthen their understanding of palliative care and boost their confidence in its application. The training includes a 45-minute e-learning module and one-hour interactive online seminars. These sessions encourage reflection and discussion of real-world cases to facilitate integration into daily practice.
2. Trigger List for Palliative Care Referrals
A 7-item trigger list developed using the Delphi method guides ICU teams in identifying appropriate times to initiate palliative care consultations. Triggers include persistent symptoms (e.g., pain, dyspnea), repeated ICU admissions, life-limiting diagnoses, and explicit requests from patients or families. This list reflects expert consensus from seven countries and is designed for practical use in clinical settings.
3. Training for Palliative Care Experts
Palliative care consultants receive structured training developed through expert input and literature review. This includes asynchronous online modules and monthly synchronous booster sessions, ensuring a standardised, patient-centred approach that aligns with ICU clinicians’ needs.
The EPIC study aims to evaluate both the clinical and economic impacts of the integrated palliative care model. The primary hypothesis is that the intervention will reduce ICU length of stay by an average of two days. From a health economics perspective, the goal is to demonstrate a cost reduction equivalent to the expense of one ICU day, with no decline in patient quality of life.
This is the first multicentre European study to rigorously assess a palliative care intervention within ICUs. EPIC offers a scalable and standardised model that leverages telemedicine to overcome access barriers and includes comprehensive education for both ICU and palliative care professionals. By enhancing mutual understanding and collaboration, the project seeks to improve patient care and inform future palliative care practices in critical care settings.
The EPIC project is funded by the European Union’s Horizon Europe research and innovation programme, the Swiss State Secretariat for Education, Research and Innovation (SERI) and the UK Research and Innovation (UKRI).
Source and Image Credit: Euroanaesthesia 2025
