Aim: There are no standardised approaches to palliative care (PC) in Ireland’s intensive care units (ICU).  There are efficacious interventions for integrating a structured approach.  However, key characteristics of these interventions are for the most part unknown.  Further, there is little understanding of the facilitators to and challenges of their sustainability and implementation, resulting in challenges to implementation and evaluation.

Therefore,  a scoping review was undertaken to: 

(1) provide an overview of key characteristics of ICU palliative interventions

(2) describe challenges to and facilitations of its integration

 

Search and review methodology: The PRSIMA for scoping reviews (PRISMA-ScR) and Arksey & O'Malley’s (2005) scoping review framework were utilised.  Cumulative Index to  Nursing  and  Allied  Health  Literature  (CINAHL), Excerpta  Medica database  (EMBASE), American  Psychological Association  (PsycINFO), Cochrane Library, Medical  Literature  Analysis  and  Retrieval  System (MEDLINE), and Web of Science were all systematically searched.  The keyword searched were ‘palliative care and intensive care unit’.  There was no restrictions on dates or locations and studies of any type evaluating or describing interventions were included.

 

Findings: We identified 7,625 publications, 416 underwent a full review resulting in 113 for inclusion. 39/113 were intervention studies, 29/113 were review studies, 10/113 were screening criteria developmental studies, 8/113 were systematic reviews.  The remaining  15/113 consisted of book chapters, monographs, editorials and reports.  The characteristics that emerged included: 1. screening criteria, 2. education, 3. Structured practices, 4. communication and 5.nurse leaders.  Misconceptions, culture of resistance, lack of knowledge, resources and socio-cultural factors were identified as challenges to implementing PC in ICU.  While education, structured protocols and local leadership were identified as facilitating factors.

Conclusion and impact:  This review offered insights into the key components that have been successfully used to integrate PC into ICU in the USA.  These findings can guide the design, application, implementation and sustainability of palliative approaches in Australia’s and European’s ICUs.