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

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Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2024-09-12 , DOI: 10.1007/s00134-024-07623-0
Stephanie A Meddick-Dyson ₁ , Jason W Boland ₁ , Mark Pearson ₁ , Sarah Greenley ₂ , Rutendo Gambe ₁ , John R Budding ₃ , Fliss E M Murtagh ₁

Affiliation

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.

中文翻译：

在重症监护病房实施姑息治疗：知识与实施研究逻辑模型的系统评价和映射

目的

重症监护病房（ICU）姑息治疗（PC）的重要性和有效性是已知的。对基于 ICU 的 PC 干预的实施和整合知之甚少。本系统综述旨在使用改良的实施研究逻辑模型（IRLM）来识别、映射和综合实施 ICU-PC（主要和/或专家）干预的证据。

方法

本系统评价使用改编的 Smith's IRLM 来了解实施因素（决定因素（障碍和促进因素）、策略和机制——之间的关系，并报告干预特征和结果。检索截至 2023 年 12 月 2 日的 MEDLINE、Embase、Cochrane、CINAHL 和 PsycINFO，以及 PC、重症监护和实施术语的组合。

结果

共纳入 84 项研究（8 项过程评价，76 项有效性研究）。关于 ICU-PC 干预的已发表证据大量，但关于实施因素的报告是可变的，而且往往缺乏，特别是对于患者和家庭相关的决定因素以及机制的所有方面。实施的主要促进因素是充足的资源以及 PC 和 ICU 团队之间的合作。实施的主要障碍是缺乏资源、对 PC 的负面看法以及 ICU 敏锐度高。实施策略包括审计资源、建立利益相关者合作、创建适应性强的干预措施、利用拥护者和支持教育。机制最常见的作用是促进协同工作。