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

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

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.

Citation

Meddick‐Dyson, S. A., Boland, J. W., Pearson, M., Greenley, S., Gambe, R., Budding, J. R., & Murtagh, F. E. (online). Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model. Intensive care medicine, https://doi.org/10.1007/s00134-024-07623-0

• Journal Article Type: Review
• Acceptance Date: Aug 20, 2024
• Online Publication Date: Sep 12, 2024
• Deposit Date: Sep 23, 2024
• Publicly Available Date: Sep 13, 2025
• Journal: Intensive Care Medicine
• Print ISSN: 0342-4642
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s00134-024-07623-0
• Keywords: Palliative care; Intensive care; Implementation science; Systematic review
• Public URL: https://hull-repository.worktribe.com/output/4834187