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Review Article
Basic science and research
Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review
Christantie Effendy, Yodang Yodang, Sarah Amalia, Erna Rochmawati
Acute Crit Care. 2022;37(4):516-526.   Published online October 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00745
  • 6,351 View
  • 405 Download
  • 8 Web of Science
  • 11 Crossref
AbstractAbstract PDF
The provision of palliative care in the intensive care unit (ICU) is increasing. While some scholars have suggested the goals of palliative care to not be aligned with the ICU, some evidence show benefits of the integration. This review aimed to explore and synthesize research that identified barriers and facilitators in the provision of palliative care in the ICU. This review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review guidelines based on population, concept, and context. We searched for eligible studies in five electronic databases (Scopus, PubMed, ProQuest, Science Direct, and Sage) and included studies on the provision of palliative care (concept) in the ICU (context) that were published in English between 2005–2021. We describe the provision of palliative care in terms of barriers and facilitators. We also describe the study design and context. A total of 14 papers was included. Several barriers and facilitators in providing palliative care in the ICU were identified and include lack of capabilities, family boundaries, practical issues, cultural differences. Facilitators of the provision of palliative care in an ICU include greater experience and supportive behaviors, i.e., collaborations between health care professionals. This scoping review demonstrates the breadth of barriers and facilitators of palliative care in the ICU. Hospital management can consider findings of the current review to better integrate palliative care in the ICU.

Citations

Citations to this article as recorded by  
  • A necessidade dos cuidados paliativos na Unidade de Terapia Intensiva (UTI)
    Larissa Kênia de Oliveira Barros Dos Santos, Isabella Rodrigues Ribeiro, João Pedro Manduca Ferreira, Victor Hugo Oliveira Moraes, Érika Aguiar Lara Pereira
    Cuadernos de Educación y Desarrollo.2024;[Epub]     CrossRef
  • End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments
    Andrea Cortegiani, Mariachiara Ippolito, Sebastiano Mercadante
    Anesthesiology Clinics.2024; 42(3): 407.     CrossRef
  • What helps or hinders effective end-of-life care in adult intensive care units in Middle Eastern countries? A systematic review
    Nabat Almalki, Breidge Boyle, Peter O’Halloran
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer
    Irene Giannubilo, Linda Battistuzzi, Eva Blondeaux, Tommaso Ruelle, Francesca Benedetta Poggio, Giulia Buzzatti, Alessia D’Alonzo, Federica Della Rovere, Maria Maddalena Latocca, Chiara Molinelli, Maria Grazia Razeti, Simone Nardin, Luca Arecco, Marta Per
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Palliative Care in the Intensive Care Unit: The Standard of Care
    Clareen Wiencek
    AACN Advanced Critical Care.2024; 35(2): 112.     CrossRef
  • Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review
    Naveen Salins, Vijay Shree Dhyani, Mebin Mathew, Ashmitha Prasad, Arathi Prahallada Rao, Anuja Damani, Krithika Rao, Shreya Nair, Vishal Shanbhag, Shwethapriya Rao, Shivakumar Iyer, Roop Gursahani, Raj Kumar Mani, Sushma Bhatnagar, Srinagesh Simha
    Intensive Care Medicine.2024; 50(9): 1438.     CrossRef
  • Barriers and Facilitators of Early Palliative Care in the Trajectory of People Living with Chronic Condition: A Mini Review Using Socio-ecological Framework to Inform Public Health Strategy
    Hartiah Haroen, Sidik Maulana, Alia Harlasgunawan, Sri Rahmawati, Alvi Riansyah, Faizal Musthofa, Jerico Pardosi
    Journal of Multidisciplinary Healthcare.2024; Volume 17: 4189.     CrossRef
  • Shared Decision-making in Palliative and End‑of‑life Care in the Cardiac Intensive Care Unit
    Sarah Godfrey, Alexis Barnes, Jing Gao, Jason N Katz, Sarah Chuzi
    US Cardiology Review.2024;[Epub]     CrossRef
  • Assessing IoT integration in ICUs’ settings and management: a cross-country analysis among local healthcare organizations
    Anna Roberta Gagliardi, Luca Carrubbo, Shai Rozenes, Adi Fux, Daniela Siano
    Digital Policy, Regulation and Governance.2024;[Epub]     CrossRef
  • Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model
    Stephanie A. Meddick‐Dyson, Jason W. Boland, Mark Pearson, Sarah Greenley, Rutendo Gambe, John R. Budding, Fliss E. M. Murtagh
    Intensive Care Medicine.2024; 50(11): 1778.     CrossRef
  • Healthcare Professionals’ Attitudes towards and Knowledge and Understanding of Paediatric Palliative Medicine (PPM) and Its Meaning within the Paediatric Intensive Care Unit (PICU): A Summative Content Analysis in a Tertiary Children’s Hospital in Scotlan
    Satyajit Ray, Emma Victoria McLorie, Jonathan Downie
    Healthcare.2023; 11(17): 2438.     CrossRef
Original Article
Ethics
The quality of dying and death for patients in intensive care units: a single center pilot study
Yanghwan Choi, Myoungrin Park, Da Hyun Kang, Jooseon Lee, Jae Young Moon, Heejoon Ahn
Acute Crit Care. 2019;34(3):192-201.   Published online April 8, 2019
DOI: https://doi.org/10.4266/acc.2018.00374
  • 9,274 View
  • 184 Download
  • 15 Web of Science
  • 12 Crossref
AbstractAbstract PDFSupplementary Material
Background
To identify the necessary care for dying patients in intensive care units (ICUs), we designed a retrospective study to evaluate the quality of dying and death (QODD) experienced by the surrogates of patients with medical illness who died in the ICU of a tertiary referral hospital.
Methods
To achieve our objective, the authors compared the QODD scores as appraised by the relatives of patients who died of cancer under hospice care with those who died in the ICU. For this study, a Korean version of the QODD questionnaire was developed, and individual interviews were also conducted.
Results
Sixteen people from the intensive care group and 23 people from the hospice care group participated in the survey and completed the questionnaire. The family members of patients who died in the ICU declined participation at a high rate (50%), with the primary reason being to avoid bringing back painful memories (14 people, 87.5%). The relatives of the intensive care group obtained an average total score on the 17-item QODD questionnaire, which was significantly lower than that of the relatives of the hospice group (48.7±15.5 vs. 60.3±14.8, P=0.03).
Conclusions
This work implies that there are unmet needs for the care of dying patients and for the QODD in tertiary hospital ICUs. This result suggests that shared decision making for advance care planning should be encouraged and that education on caring for dying patients should be provided to healthcare professionals to improve the QODD in Korean ICUs.

Citations

Citations to this article as recorded by  
  • Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021
    Seung Hwan Kim, Ji Hwan Jang, Young Zoon Kim, Kyu Hong Kim, Taek Min Nam
    Journal of Korean Neurosurgical Society.2024; 67(1): 73.     CrossRef
  • Family Members’ Feedback on the “Quality of Death” of Adult Patients Who Died in Intensive Care Units and the Factors Affecting the Death Quality: A Systematic Review and Meta-Analysis
    Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Shun Yoshihara, Yuma Ota, Saiko Okamoto, Ayako Fukushima, Haruyoshi Hirashima
    Cureus.2024;[Epub]     CrossRef
  • Factors associated with the quality of dying and death and missed nursing care
    Shahin Gahramani, Mokhtar Mahmoudi, Nouri, Sina Valiee
    International Journal of Palliative Nursing.2024; 30(4): 190.     CrossRef
  • Bereaved family members’ perspectives on quality of death in deceased acute cardiovascular disease patients compared with cancer patients – a comparison of the J-HOPE3 study and the quality of palliative care in heart disease (Q-PACH) study
    Takahiro Suzuki, Mitsunori Miyashita, Takashi Kohno, Jeffrey Rewley, Naoko Igarashi, Maho Aoyama, Michiaki Higashitani, Naoto Kawamatsu, Takeshi Kitai, Tatsuhiro Shibata, Makoto Takei, Kotaro Nochioka, Gaku Nakazawa, Hiroki Shiomi, Shigeru Tateno, Toshihi
    BMC Palliative Care.2024;[Epub]     CrossRef
  • Intensive care unit interventions to improve quality of dying and death: scoping review
    Kazuaki Naya, Hideaki Sakuramoto, Gen Aikawa, Akira Ouchi, Yusuke Oyama, Yuta Tanaka, Kentaro Kaneko, Ayako Fukushima, Yuma Ota
    BMJ Supportive & Palliative Care.2024; 14(e2): e1689.     CrossRef
  • Associations between palliative-care consultations and end-of-life quality in cancer patients’ last 6 months
    Shan Ting Chen, San Chi Chen, Hsing Jung Lee, Chen Hsiu Chen
    Supportive Care in Cancer.2024;[Epub]     CrossRef
  • Quality of dying and death in intensive care units: family satisfaction
    Fur-Hsing Wen, Ming Chu Chiang, Chung-Chi Huang, Tsung-Hui Hu, Wen-Chi Chou, Li-Pang Chuang, Siew Tzuh Tang
    BMJ Supportive & Palliative Care.2023; 13(e3): e1217.     CrossRef
  • Development of an End-of-Life Nursing Care Protocol for Intensive Care Units
    Jungeun Kim, Hye Young Yun, Euni Ji Kim, Hyunsook Kim, Geon Ah Kim, Sung Ha Kim, Jayoung Koo, Ju Youn Park, Aisoon Park, Eugene Han, So Yeon Kim, Jihye Jeong, Sanghee Kim
    Journal of Hospice & Palliative Nursing.2022; 24(4): E159.     CrossRef
  • Nurses’ perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: a cross-sectional study
    Dan-dan Xu, Dan Luo, Jie Chen, Ji-li Zeng, Xiao-lin Cheng, Jin Li, Juan-juan Pei, Fen Hu
    BMC Palliative Care.2022;[Epub]     CrossRef
  • The Quality of Dying and Death of Advanced Cancer Patients in Palliative Care and Its Association With Place of Death and Quality of Care
    Daniel Gutiérrez-Sánchez, Rafael Gómez-García, María Luisa Martín Roselló, Antonio I. Cuesta-Vargas
    Journal of Hospice & Palliative Nursing.2021; 23(3): 264.     CrossRef
  • The Role of Anesthesiologists in Perioperative Limitation of Potentially Life-Sustaining Medical Treatments: A Narrative Review and Perspective
    Tera Cushman, David B. Waisel, Miriam M. Treggiari
    Anesthesia & Analgesia.2021;[Epub]     CrossRef
  • Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
    Wan-Na Sun, Hsin-Tien Hsu, Nai-Ying Ko, Yu-Tung Huang
    International Journal of Environmental Research and Public Health.2020; 17(12): 4443.     CrossRef
Review Article
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean J Crit Care Med. 2013;28(3):163-172.
DOI: https://doi.org/10.4266/kjccm.2013.28.3.163
  • 3,989 View
  • 169 Download
  • 8 Crossref
AbstractAbstract PDF
The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient's autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient's death in imminent. To improve understanding EOL care of terminally ill patients, we summarize 'Recommendations for EOL care in the ICU by the American College of Critical Care Medicine' and 'Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science'. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

Citations

Citations to this article as recorded by  
  • A Scoping Review of End-Of-Life Care Education Programs for Critical Care Nurses
    Eugene HAN, Sumi CHOI, Ki Young YUN, Sung Ha KIM, Sanghee KIM, Hye Young YUN
    Korean Journal of Medical Ethics.2023; 26(3): 185.     CrossRef
  • Comparison of the Characteristics Among Deceased Do-Not-Attempt-Resuscitation (DNAR) Cancer Patients in Hospice and Oncology Wards
    Nan Song, Ja Yun Choi
    Asian Oncology Nursing.2020; 20(1): 10.     CrossRef
  • Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction
    Kkot Bi Jeon, Mihyun Park
    Journal of Korean Academy of Nursing Administration.2019; 25(1): 42.     CrossRef
  • Difficulties in End-of-Life Care and Educational Needs of Intensive Care Unit Nurses: A Mixed Methods Study
    Hyun Sook Kim, Eun Kyoung Choi, Tae Hee Kim, Hye Young Yun, Eun Ji Kim, Jin Ju Hong, Jeong A Hong, Geon Ah Kim, R.N. Sung Ha Kim
    The Korean Journal of Hospice and Palliative Care.2019; 22(2): 87.     CrossRef
  • Factors Influencing Performance of End-of-life Care by ICU Nurses
    Mun Jung Ko, So-Hyun Moon
    Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 327.     CrossRef
  • Development of an Electronic Document for DNR Informed Consent based on the Electronic Medical Record System
    Ji-Kyeong Park
    The Korean Journal of Health Service Management.2016; 10(3): 99.     CrossRef
  • Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
    Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
    The Korean Journal of Critical Care Medicine.2015; 30(2): 73.     CrossRef
  • Application of Animation Mobile Electronic Informed Consent in Inpatient of Long-term Care Hospital: Focused on DNR Informed Consent
    Ji-Kyeong Park, Ji-On Kim
    Journal of Digital Convergence.2015; 13(11): 187.     CrossRef
Original Articles
Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
Jae Young Moon, Hee Young Lee, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2012;27(1):16-23.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.16
  • 3,216 View
  • 33 Download
  • 5 Crossref
AbstractAbstract PDF
BACKGROUND
In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines.
METHODS
The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers.
RESULTS
75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying.
CONCLUSIONS
In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent.

Citations

Citations to this article as recorded by  
  • Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses
    Eun Kyung Choi, Jiyeon Kang, Hye Youn Park, Yu Jung Kim, Jinui Hong, Shin Hye Yoo, Min Sun Kim, Bhumsuk Keam, Hye Yoon Park
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities
    Sooyoun Han
    Asian Social Work and Policy Review.2016; 10(2): 200.     CrossRef
  • A Study of Social Workers’ Understanding of Elderly Patients’ and Family Caregivers’ Rights to End-of-Life Care Decisions and of Their Own Roles in the Process
    Sooyoun Han
    The Korean Journal of Hospice and Palliative Care.2015; 18(1): 42.     CrossRef
  • The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
  • The End-of-Life Care in the Intensive Care Unit
    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
Do-not-resuscitate Order in Patients, Who Were Deceased in a Medical Intensive Care Unit of an University Hospital in Korea
Kwangha Lee, Hang Jea Jang, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2008;23(2):84-89.
DOI: https://doi.org/10.4266/kjccm.2008.23.2.84
  • 4,095 View
  • 63 Download
  • 16 Crossref
AbstractAbstract PDF
BACKGROUND
Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient's family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006.
METHODS
The charts of patients who had died in the medical ICU were retrospectively reviewed.
RESULTS
One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 +/- 14.0 and 23.2 +/- 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%).
CONCLUSIONS
DNR orders are well-accepted by the patient's family in the ICU. However, DNR orders are initiated when patient death is imminent.

Citations

Citations to this article as recorded by  
  • Act on Decisions on Life-Sustaining Treatment and Timing of Referral to Hospice
    Han-na Ju, Seung Hun Lee, Yun-Jin Kim, Sang-Yeoup Lee, Jeong-Gyu Lee, Yu-Hyeon Yi, Young-Hye Cho, Young-Jin Tak, Hye-Rim Hwang, Eun-Ju Park, Young-In Lee
    Korean Journal of Family Practice.2021; 11(5): 331.     CrossRef
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    Jung-Ja Choi, Su Hyun Kim, Shin-Woo Kim
    Journal of Korean Academy of Nursing.2019; 49(3): 329.     CrossRef
  • End-of-Life Care Practice in Dying Patients with Do-Not-Resuscitate Order: A Single Center Experience
    Sang Eun Yoon, Eun Mi Nam, Soon Nam Lee
    The Korean Journal of Hospice and Palliative Care.2018; 21(2): 51.     CrossRef
  • Intensive Care Nurses’ Experiences of Death of Patients with DNR Orders
    Ji Yun Lee, Yong Mi Lee, Jae In Jang
    The Korean Journal of Hospice and Palliative Care.2017; 20(2): 122.     CrossRef
  • Trends in the Use of Intensive Care by Very Elderly Patients and Their Clinical Course in a Single Tertiary Hospital in Korea
    Junghyun Kim, Jungkyu Lee, Sunmi Choi, Jinwoo Lee, Young Sik Park, Chang-Hoon Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Sang-Min Lee
    Korean Journal of Critical Care Medicine.2016; 31(1): 25.     CrossRef
  • Clinical Characteristics of Oncologic Patients with DNR Decision at a Tertiary Hospital
    Na Young Kang, Jeong Yun Park
    The Korean Journal of Hospice and Palliative Care.2016; 19(1): 26.     CrossRef
  • Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units
    Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na
    The Korean Journal of Critical Care Medicine.2015; 30(2): 73.     CrossRef
  • Do-not-resuscitation in Terminal Cancer Patient
    Jung Hye Kwon
    The Korean Journal of Hospice and Palliative Care.2015; 18(3): 179.     CrossRef
  • Research Trend Analysis of Do-Not-Resuscitate Decision: Based on Text Network Analysis
    Miji Kim, Sangmi Noh, Eunjung Ryu, Sangmoon Shin
    Asian Oncology Nursing.2014; 14(4): 254.     CrossRef
  • The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
  • The End-of-Life Care in the Intensive Care Unit
    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
  • Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
    Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
    Korean Journal of Critical Care Medicine.2012; 27(1): 16.     CrossRef
  • Current status of end-of-life care in Korean hospitals
    Younsuck Koh
    Journal of the Korean Medical Association.2012; 55(12): 1171.     CrossRef
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    Young-Rye Park, Jin-A Kim, Kisook Kim
    Nursing Ethics.2011; 18(6): 802.     CrossRef
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    Hyun Sook Kim, Shinmi Kim, Su Jeong Yu, Moungok Kim
    The Korean Journal of Hospice and Palliative Care.2010; 13(1): 41.     CrossRef
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    Younsuck Koh
    Journal of the Korean Medical Association.2009; 52(9): 871.     CrossRef

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