Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review
BMC palliative care, 2020•Springer
Background While a palliative approach is generally perceived to be an integral part of the
intensive care unit (ICU), the provision of palliative care in this setting is challenging. This
review aims to identify factors (barriers and facilitators) influencing a palliative approach in
intensive care settings, as perceived by health care professionals. Method A systematic
mixed-methods review was conducted. Multiple electronic databases were used, and the
following search terms were utilized: implementation, palliative care, and intensive care unit …
intensive care unit (ICU), the provision of palliative care in this setting is challenging. This
review aims to identify factors (barriers and facilitators) influencing a palliative approach in
intensive care settings, as perceived by health care professionals. Method A systematic
mixed-methods review was conducted. Multiple electronic databases were used, and the
following search terms were utilized: implementation, palliative care, and intensive care unit …
Background
While a palliative approach is generally perceived to be an integral part of the intensive care unit (ICU), the provision of palliative care in this setting is challenging. This review aims to identify factors (barriers and facilitators) influencing a palliative approach in intensive care settings, as perceived by health care professionals.
Method
A systematic mixed-methods review was conducted. Multiple electronic databases were used, and the following search terms were utilized: implementation, palliative care, and intensive care unit. In total, 1843 articles were screened, of which 24 met the research inclusion/exclusion criteria. A thematic synthesis method was used for both qualitative and quantitative studies.
Results
Four key prerequisite factors were identified: (a) organizational structure in facilitating policies, unappropriated resources, multi-disciplinary team involvement, and knowledge and skills; (b) work environment, including physical and psychosocial factors; (c) interpersonal factors/barriers, including family and patients’ involvement in communication and participation; and (d) decision-making, e.g., decision and transition, goal conflict, multidisciplinary team communication, and prognostication.
Conclusion
Factors hindering the integration of a palliative approach in an intensive care context constitute a complex interplay among organizational structure, the care environment and clinicians’ perceptions and attitudes. While patient and family involvement was identified as an important facilitator of palliative care, it was also recognized as a barrier for clinicians due to challenges in shared goal setting and communication.
Springer
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