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Between 2000 and 2009, the proportion of Medicare beneficiaries who spent time in an intensive care unit (ICU) during their last month of their life steadily increased to 29%. (Teno JM et al. JAMA 2013;309(5):470-477)  The number of ICU beds per 100,000 people in the United States also increased by 7.4% and critical care medicine costs nearly doubled. (Halpern NA et al. Crit Care Med 2016;44(8):1490-1499)    

Many ICU patients are unable to communicate as a result of their illness. Unfortunately, family members of these patients report high levels of conflict with clinicians, are unsure of their loved one's prognosis, struggle with decisions about their loved one's care, and experience substantial symptoms of anxiety, depression, and post-traumatic stress even if their loved one survives. 

The Partnership for ICU Patient-Family Engagement Research (PIPER), led by Alison E. Turnbull, DVM, MPH, PhD at Johns Hopkins University School of Medicine, is a multidisciplinary group of researchers, clinicians, ICU families, and survivors investigating ways to ensure that ICU patients and their families are appropriately engaged in decision-making about patient care.