{'fraction_non_alphanumeric': 0.023110255175734232, 'fraction_numerical': 0.00048146364949446316, 'mean_word_length': 5.040697674418604, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Reply: Palliative care: a core competency for intensive care unit doctors.

From the Authors: 
 
We thank Dr. Lamas and colleagues for their comments related to our article on estimating palliative care needs in critically ill patients (1). We agree that integrative models of palliative care in intensive care units (ICUs) certainly deserve further study and attention. This method of delivering palliative care is essential not only because there is a shortage of fellowship-trained palliative care specialists to meet these needs but also as a matter of professional integrity for critical care providers to be able to have the competencies to treat pain and symptoms common in this population, facilitate goals-of-care conversations, and provide high-quality end-of-life care for patients who die in the ICU. 
 
An ongoing challenge is how to best allocate specialized palliative care. The role of specialized palliative care is likely to change depending on the practice setting. For example, in ICUs with an open staffing model, patients may not have a primary critical care provider who is concerned with the provision of adequate palliative care, and palliative care consultants may be needed to perform a needs assessment; in closed units with adequate training, palliative care consultation may be reserved for only the most challenging cases: difficult-to-manage symptoms, complex decision making, or conflict resolution. As with any other consultation service, the amount of specialist involvement that is required inherently depends on the services that can be provided by the primary team. 
 
Adequate delivery of palliative care to critically ill patients should be a high priority, and figuring out how to best meet these needs will require buy-in and cooperation from ICU clinicians, palliative care specialists, patients’ primary physicians, and hospital administrators. It is imperative that we collaborate together, and, as Dr. Lamas and colleagues point out, study interventions, to create best practices and models that allow us to reach this common goal.