Palliative Care in the Intensive Care Unit

Kamel, Ghassan; Paniagua, Miguel; Uppalapati, Aditya

doi:10.1177/1049909114536979

Cited by 17 publications

(19 citation statements)

References 14 publications

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“…A summary of all included articles and their quality assessments are shown in (see Tables 1 , 2 , and 3 ). In total, eight articles were assessed as having either moderate-to-high or high quality, eight articles were assessed as having moderate quality, four articles were assessed as having low-to-moderate quality, and four articles were assessed as having low quality (reference [ 33 , 34 , 38 , 40 ]) (see additional file 2 ) .…”

Section: Resultsmentioning

confidence: 99%

“…The ethical issues were the poor expected quality of life ( P = 0.001), the patient wanting to limit medical care ( P = 0.002), interoperative course ( P = 0.054), and the family choice ( P = 0.032). *Ethical aspects influence the decision-making process Low Kamel, G [ 34 ] 2015/USA To identify residents’ knowledge and their perceived barriers of PC-end-of-life (EOL) care utilization in the ICU Residents (n = 30) Cross-sectional study Residents stated that the greatest failure was in the goals of care provided by the medical teams and those expected by the patients and their families, cited by 18.7% of respondents. The patient was required to be terminally ill before a successful palliative care consultation could be obtained (22.9%).…”

Section: Resultsmentioning

confidence: 99%

“…- Facilitating palliative care dialogue (standardized tools) [ 38 ]. Policies and guidelines - Lack of protocol and policies guiding palliative care in ICU [ 22 , 23 , 34 ]. - Lack of written protocol for palliative care nursing such as pain management, dyspnoea, etc.…”

Section: Resultsmentioning

confidence: 99%

“… - Involvement of stakeholders from different levels and specialties [ 39 ]. - Direct palliative care team involvement in care for patients in ICU [ 34 ]. 2- Working environment Physical environment - Absence of infrastructure in the ICU to facilitate family involvement in palliative care (insufficient space for meetings) [ 20 , 25 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

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Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review

et al. 2020

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Background While a palliative approach is generally perceived to be an integral part of the intensive care unit (ICU), the provision of palliative care in this setting is challenging. This review aims to identify factors (barriers and facilitators) influencing a palliative approach in intensive care settings, as perceived by health care professionals. Method A systematic mixed-methods review was conducted. Multiple electronic databases were used, and the following search terms were utilized: implementation, palliative care, and intensive care unit. In total, 1843 articles were screened, of which 24 met the research inclusion/exclusion criteria. A thematic synthesis method was used for both qualitative and quantitative studies. Results Four key prerequisite factors were identified: (a) organizational structure in facilitating policies, unappropriated resources, multi-disciplinary team involvement, and knowledge and skills; (b) work environment, including physical and psychosocial factors; (c) interpersonal factors/barriers, including family and patients’ involvement in communication and participation; and (d) decision-making, e.g., decision and transition, goal conflict, multidisciplinary team communication, and prognostication. Conclusion Factors hindering the integration of a palliative approach in an intensive care context constitute a complex interplay among organizational structure, the care environment and clinicians’ perceptions and attitudes. While patient and family involvement was identified as an important facilitator of palliative care, it was also recognized as a barrier for clinicians due to challenges in shared goal setting and communication.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review

et al. 2020

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“…Professionals with higher levels of education are able to develop their awareness about the purposes of care provision in their field of practice. Through education, death may not be seen as frustration or failure [ 5 , 18 , 80 ] and communication and end-of-life decision-making may be improved; for instance, by providing education about PC to professionals working in ICUs [ 81 , 82 ]. By creating awareness, education about palliative care may also increase healthcare professionals’ perceptions of self-efficacy and empowerment.…”

Section: Discussionmentioning

confidence: 99%

Compared to Palliative Care, Working in Intensive Care More than Doubles the Chances of Burnout: Results from a Nationwide Comparative Study

et al. 2016

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IntroductionProfessionals working in intensive and palliative care units, hence caring for patients at the end-of-life, are at risk of developing burnout. Workplace conditions are determinant factors to develop this syndrome among professionals providing end-of-life care.ObjectivesTo identify and compare burnout levels between professionals working in intensive and palliative care units; and to assess which workplace experiences are associated with burnout.MethodsA nationwide, multicentre quantitative comparative survey study was conducted in Portugal using the following instruments: Maslach Burnout Inventory–Human Services Survey, Questionnaire of workplace experiences and ethical decisions, and Questionnaire of socio-demographic and professional characteristics. A total of 355 professionals from 10 intensive care and 9 palliative care units participated in the survey. A series of univariate and multivariate logistic regression analyses were performed; odds ratio sidelong with 95% confidence intervals were calculated.Results27% of the professionals exhibited burnout. This was more frequent in intensive care units (OR = 2.525, 95% CI: 1.025–6.221, p = .006). Univariate regression analyses showed that higher burnout levels were significantly associated with conflicts, decisions to withhold/withdraw treatment, and implementing palliative sedation. When controlling for socio-demographic and educational characteristics, and setting (intensive care units versus palliative care units), higher burnout levels were significantly and positively associated with experiencing conflicts in the workplace. Having post-graduate education in intensive/palliative care was significantly but inversely associated to higher burnout levels.ConclusionsCompared to palliative care, working in intensive care units more than doubled the likelihood of exhibiting burnout. Experiencing conflicts (e.g., with patients and/or families, intra and/or inter-teams) was the most significant determinant of burnout and having post-graduate education in intensive/palliative care protected professionals from developing this syndrome. This highlights the need for promoting empowering workplace conditions, such as team empowerment and conflict management. Moreover, findings suggest the need for implementing quality improvement strategies and organizational redesign strategies aimed at integrating the philosophy, principles and practices of palliative care in intensive care units.

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Inadequate Palliative Care in Lung Disease

Villalobos

Kreuter

2021

Respiratory Medicine

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Palliative Care in the Intensive Care Unit

Abstract: Teaching should focus on overcoming the identified barriers especially communication with patients and their families. More studies are needed to identify the best method to teach Palliative care in the ICU.

Cited by 17 publications

References 14 publications

Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review

Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review

Compared to Palliative Care, Working in Intensive Care More than Doubles the Chances of Burnout: Results from a Nationwide Comparative Study

Inadequate Palliative Care in Lung Disease

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