Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model

Stephanie A Meddick-Dyson; Jason W Boland; Mark Pearson; Sarah Greenley; Rutendo Gambe; John R Budding; Fliss E M Murtagh

doi:10.1007/s00134-024-07623-0

Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model

Intensive Care Med. 2024 Nov;50(11):1778-1790. doi: 10.1007/s00134-024-07623-0. Epub 2024 Sep 12.

Authors

Stephanie A Meddick-Dyson¹, Jason W Boland², Mark Pearson², Sarah Greenley³, Rutendo Gambe², John R Budding⁴, Fliss E M Murtagh²

Affiliations

¹ Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK. stephanie.meddick-dyson@nhs.net.
² Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
³ Cancer Awareness, Screening and Diagnostic Pathways Research Group (CASP), Hull York Medical School, University of Hull, Hull, UK.
⁴ University Hospitals of Leicester NHS Trust, Leicester, UK.

PMID: 39266771
DOI: 10.1007/s00134-024-07623-0

Abstract

Purpose: The importance and effectiveness of palliative care (PC) in intensive care units (ICU) are known. Less is known about the implementation and integration of ICU-based PC interventions. This systematic review aims to use a modified implementation research logic model (IRLM) to identify, map, and synthesise evidence on implementation of ICU-PC (primary and/or specialist) interventions.

Methods: This systematic review used an adapted Smith's IRLM to understand relationships between implementation factors-determinants (barriers and facilitators), strategies, and mechanisms-and report intervention characteristics and outcomes. Searches up to 2nd December 2023, of MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO, combined PC, intensive care, and implementation terms.

Results: 84 studies (8 process evaluations, 76 effectiveness studies) were included. Published evidence on ICU-PC interventions is substantial, but reporting on implementation factors is variable and often lacking, especially for patient and family-related determinants and for all aspects of mechanisms. Main facilitators for implementation are adequate resources and collaboration between PC and ICU teams. Main barriers to implementation are lack of resources, negative perceptions of PC, and high ICU acuity. Implementation strategies include auditing resources, building stakeholder collaboratives, creating adaptable interventions, utilising champions, and supporting education. Mechanisms most commonly worked by facilitating collaborative working.

Conclusion: This review provides recommendations for ICUs when designing (stakeholder involvement, ICU-PC collaboration, assessment of culture and resources); implementing (targeted and adapted strategies, champions, and education); and evaluating/reporting (collect effectiveness and implementation data, including mechanisms) ICU-PC interventions. Use of implementation structures and patient/family involvement are both needed and important to be included.

Keywords: Implementation science; Intensive care; Palliative care; Systematic review.

Publication types

Systematic Review

MeSH terms

Critical Care / methods
Critical Care / standards
Humans
Intensive Care Units* / organization & administration
Palliative Care* / methods
Palliative Care* / standards

Grants and funding

ACF-2021-03-005/National Institute for Health and Care Research