Intensive Care Medicine, Published: 14 August 2024
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.
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