Factors influencing integrated palliative care processes in intensive care units: a mixed methods systematic review

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Introduction: Although survival is a central goal for intensive care, some patients die in the ICU or shortly after discharge. For patients with critical illnesses who may or may not survive a palliative approach is suggested to improve their quality of life and to support their families. However, we lack knowledge about adapting, integrating and adopting a palliative care approach in the ICU setting. Objectives/Aims: This review aims to identify factors influencing the integration of a palliative care approach in the ICU setting as perceived by healthcare professionals. Methods: A systematic mixed methods review was conducted and data were analysed by applying a thematic synthesis. Multiple databased were used for systematic searches with the following terms: palliative care, implementation and ICU. A total of 1843 studies were identified and screened, and 24 studies were included for this review. Results: Three key prerequisites to integrate and adopt palliative care approaches in ICU were identified that acts as enablers and barriers factors for integration and adoption of palliative care in ICU (a) family-centred care factors including patient and family involvements with care; communication; b) decision and transition including decision making; goal conflict; and (c) organisational culture including facilitating policies and guidelines, knowledge and skill, multi-disciplinary team and, environmental care. Conclusion: The outcomes provide important guidance to the development of implementation strategies for palliative care approaches in the ICU setting. Acknowledging the enabling yet hindering prerequisite of family-centred care, decision and transition of goal and organisational culture are important for implementing palliative care approaches into ICU settings. Training and education are important for healthcare professionals and mangers to ensure that hindering factors are successfully solved and palliative care provided to all patients and families in ICU.