Palliative care focuses on the physical, spiritual, and emotional aspects of a person. This comprehensive approach increases patient and family satisfaction, reduces patient suffering, provides cost savings for the institution, and reduces burnout among staff. In order for patients and caregivers as well as the institutions and staff serving them to benefit from the many advantages of incorporating palliative care, barriers to use and solutions to effective implementation need to be identified.
Methods
The database PubMed, Cochrane Library and EMBASE were searched using the search terms “Palliative Care,” “intensive care,” “Integration Model,” “palliative therapy,” “outcomes,” “delivery,” “integration,” MeSH term “ICU” and palliative*. Studies published in the English language from January 2011 were included. Studies pertaining to “end-of-life” “hospice” “non-intensive hospital units” were excluded. Case studies and opinion pieces were excluded. Systematic Reviews were analyzed using AMSTAR2 with a second reviewer. From 563 articles, 543 non-relevant papers from titles or abstracts were excluded. 6 of the remaining 20 met inclusion criteria and addressed the objective.
Conclusion
When implanting the “integrative model” and having the nurses learn and use a screening tool to refer patients to the palliative care service, referrals increased but the appropriateness of the referrals was not concluded. In contrast, when the “consultative model” was used that included a team to conduct palliative care rounds on patients in the ICU there was an increase in pain management, hospice referrals, and a decrease in the length of stay.
Implication for Practice
The effective use of the “consultative model” via the use of a palliative care team yielded increased patient satisfaction, ensured a patient-centered comprehensive approach to care, and provided the hospital with financial savings as a result of curtailing unwarranted patient care. It is pivotal for clinicians to understand the existent models to know how to properly introduce palliative care in the intensive care unit to generate the best patient and institutional outcomes.
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