Abstract
Purpose
The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear.
Methods
We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries.
Results
Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies.
Conclusion
Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.
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Availability of data and material
Upon request from the corresponding author.
Change history
21 December 2021
A Correction to this paper has been published: https://doi.org/10.1007/s00134-021-06600-1
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VM, AD, SV, NA, SB, IvD, JED, RTG: no CoI. RA: Patient-Centred Outcomes Research Institute. CH: German Innovations Fund of the Federal Joint Committee in Germany, European Society of Intensive Care Medicine. JRC: National Institutes of Health and the Cambia Health Foundation.
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Metaxa, V., Anagnostou, D., Vlachos, S. et al. Palliative care interventions in intensive care unit patients. Intensive Care Med 47, 1415–1425 (2021). https://doi.org/10.1007/s00134-021-06544-6
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DOI: https://doi.org/10.1007/s00134-021-06544-6