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. 2024 Sep;50(9):1438-1458.
doi: 10.1007/s00134-024-07565-7. Epub 2024 Aug 14.

Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review

Naveen Salins  1 , Vijay Shree Dhyani  2 , Mebin Mathew  3 , Ashmitha Prasad  3 , Arathi Prahallada Rao  4 , Anuja Damani  1 , Krithika Rao  1 , Shreya Nair  1 , Vishal Shanbhag  5 , Shwethapriya Rao  5 , Shivakumar Iyer  6 , Roop Gursahani  7 , Raj Kumar Mani  8 , Sushma Bhatnagar  9 , Srinagesh Simha  3
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Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review

Naveen Salins et al. Intensive Care Med. 2024 Sep.

Abstract

Purpose: Intensive care units (ICUs) have significant palliative care needs but lack a reliable care framework. This umbrella review addresses them by synthesising palliative care practices provided at end-of-life to critically ill patients and their families before, during, and after ICU admission.

Methods: Seven databases were systematically searched for systematic reviews, and the umbrella review was conducted according to the guidelines laid out by the Joanna Briggs Institute (JBI).

Results: Out of 3122 initial records identified, 40 systematic reviews were included in the synthesis. Six key themes were generated that reflect the palliative and end-of-life care practices in the ICUs and their outcomes. Effective communication and accurate prognostications enabled families to make informed decisions, cope with uncertainty, ease distress, and shorten ICU stays. Inter-team discussions and agreement on a plan are essential before discussing care goals. Recording care preferences prevents unnecessary end-of-life treatments. Exceptional end-of-life care should include symptom management, family support, hydration and nutrition optimisation, avoidance of unhelpful treatments, and bereavement support. Evaluating end-of-life care quality is critical and can be accomplished by seeking family feedback or conducting a survey.

Conclusion: This umbrella review encapsulates current palliative care practices in ICUs, influencing patient and family outcomes and providing insights into developing an appropriate care framework for critically ill patients needing end-of-life care and their families.

Keywords: Critically ill patients; Intensive care; Overview of reviews; Palliative care; Supportive care.

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Conflict of interest statement

The Authors declare no competing interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Year-wise distribution of published systematic reviews. This figure illustrates the distribution of review publications by year, revealing a peak in 2016 with eight publications, making up 21% of the total. This is followed by 2022 with seven publications, and 2019 and 2020 contribute six publications. All the included reviews were published between 2011 and 2023
Fig. 3
Fig. 3
Synthesis of palliative and end of life care practices in the intensive care units
See this image and copyright information in PMC

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