Abstract
BackgroundWhile 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.MethodA 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.ResultsFour 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.ConclusionFactors 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.
Highlights
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
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
Thematic analysis has been used in mixedmethods systematic reviews that address questions such as identifying barriers or facilitators from evidence and Results Study characteristics and quality assessment summary: Fig. 1 shows a standard flow chart reporting the results of the bibliographic search and screening (it follows the guidance of the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA)
Summary
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. A palliative approach aims to relieve suffering for patients with life-limiting conditions and for those who are dying and to manage symptoms, increase the level of care comfort and provide support to family members [8, 9]. Despite increasing awareness of integrating a palliative care approach in the ICU, there are challenges, given the somewhat contradictory aims of intensive care and palliative care, i.e., in providing lifesaving treatments vs treating dying as a normal process. The integration of a palliative approach has been described as challenged by a lack of resources for symptom management and cultural and societal values and beliefs about death and dying [15]; structural barriers (for example, limited specialties and resources) appear especially difficult to change [16]
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