Co-developing an Implementation Toolkit for Palliative Care in the Intensive Care Unit

Project Description

Summary of the problem (Background)

The Intensive Care Unit (ICU) is a specialised ward where patients with life-threatening illness receive care. Time in the ICU can be distressing for patients and their loved ones. It can involve difficult to manage symptoms, hard discussions, and emotional decisions. Palliative care is an approach that can help in these situations to improve the quality of life of ICU patients and their families. It reduces suffering through the recognition and treatment of pain and other problems, whether physical, emotional, social, or spiritual. Research so far tells us there are needs going unmet. These include adequate communication, matching patient care with patient wishes, symptom management, and family support.

An issue when trying to develop a change across intensive care units is that they all run differently. The interaction between the intensive care team and the palliative care team, and who delivers the palliative care, is variable. This means that plans must be tailored for each individual ICU, to address their own obstacles and use their strengths. We can look to previous research, as well as asking healthcare professionals and public members with experience, to find common barriers, strengths, and ways to use these. Combining and sharing this knowledge can help ICUs to create their own tailored plan, considering things they may not otherwise have. This will save them time and resources while increasing the chance of the change working.

What I aim to do: (Aims)

I aim to provide intensive care units with information tools to create their own plan to improve palliative care for their patients and families. The tools will allow them to make good use of resources, ensure staff are supported, and the plan is practical in real life.

Methods:

This project will have two parts. I will call these parts workstream 1 and workstream 2.

Workstream 1:
Before starting this project, I have reviewed previous research where intensive care units have made changes to improve palliative care.

Step 1: I will use my findings from this work to create a list of any obstacles (barriers), anything found to have helped (facilitators), and ways to use these that have been noted (strategies).

Step 2: There are published frameworks to help us give common names to and communicate these barriers, facilitators and strategies. It would be helpful to translate my list into this shared language. To do this I will involve those with experience of palliative care in the ICU to make sure they agree with the final translated list.

Step 3: I will take the finalised list and create a survey to ask those with experience of palliative care in the ICU which of these barriers, facilitators, and strategies they have seen in their experience. This will help me to see which are the most common.

Step 4: Using the information from Steps 1-3, I will then be able to work with those with experience of palliative care in the ICU create a reference guide of these common barriers, facilitators, and strategies supported by evidence and experience. ICUs will be able to use this guide when they are designing their own project to improve palliative care.

Workstream 2:

It would be useful to understand more about how these barriers, facilitators and strategies work in practice. To investigate these processes, teachings suggest that we need to use a theory (a system of ideas intended to explain something). Before starting this work, I conducted a survey where I used such a theory to structure my questions. I asked healthcare professionals with experience of delivering palliative care in the ICU questions on what they did to make palliative care a normal part of their work on the ICU. Surveys give a helpful, but superficial view of information. This workstream will involve using the same theory to develop interview questions to gain this deeper information.