Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review
Abstract 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 inten...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12904-020-00616-y |
| _version_ | 1818146834720227328 |
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| author | Hanan Hamdan Alshehri Sepideh Olausson Joakim Öhlén Axel Wolf |
| author_facet | Hanan Hamdan Alshehri Sepideh Olausson Joakim Öhlén Axel Wolf |
| author_sort | Hanan Hamdan Alshehri |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-11T12:25:39Z |
| format | Article |
| id | doaj.art-994887104f5a4d21a92bacaedb777a8d |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-11T12:25:39Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-994887104f5a4d21a92bacaedb777a8d2022-12-22T01:07:23ZengBMCBMC Palliative Care1472-684X2020-07-0119111810.1186/s12904-020-00616-yFactors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods reviewHanan Hamdan Alshehri0Sepideh Olausson1Joakim Öhlén2Axel Wolf3Institute of Health and Care Sciences, Sahlgrenska Academy, University of GothenburgInstitute of Health and Care Sciences, Sahlgrenska Academy, University of GothenburgInstitute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of GothenburgInstitute of Health and Care Sciences, Sahlgrenska Academy, University of GothenburgAbstract 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.http://link.springer.com/article/10.1186/s12904-020-00616-yPalliative careCritical careImplementation scienceIntensive care unitsReview |
| spellingShingle | Hanan Hamdan Alshehri Sepideh Olausson Joakim Öhlén Axel Wolf Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review BMC Palliative Care Palliative care Critical care Implementation science Intensive care units Review |
| title | Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review |
| title_full | Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review |
| title_fullStr | Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review |
| title_full_unstemmed | Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review |
| title_short | Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review |
| title_sort | factors influencing the integration of a palliative approach in intensive care units a systematic mixed methods review |
| topic | Palliative care Critical care Implementation science Intensive care units Review |
| url | http://link.springer.com/article/10.1186/s12904-020-00616-y |
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