Barriers and facilitators to explore palliative care implementation in the ICU from tripartite perspectives: a qualitative systematic review and meta-aggregation

Abstract

Objective To synthesise qualitative studies on the experiences and perceptions of palliative care in the intensive care unit (ICU) among healthcare providers, patients and families. Design Meta-aggregation. Methods Published and unpublished literature from January 2025 was retrieved from MEDLINE (via PubMed), EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO, Google Scholar and four Chinese databases (CNKI, WANGFANG DATA, Vip and Sinomed). The qualitative research population includes ICU healthcare providers, patients or their families. The Phenomenon of Interest (I) was to uncover the barriers and facilitators that influenced the implementation of palliative care in the ICU by collecting the perceptions of ICU healthcare providers, patients and family members about palliative care. Two reviewers independently screened, appraised and extracted data using Joanna Briggs Institute (JBI) tools; findings were graded as unequivocal, credible or not supported. Meta-aggregation followed the JBI three-step procedure. Results The review incorporated 31 articles, yielding 534 findings with credibility ratings of ‘unequivocal’ or ‘credible’. The findings were categorised into 10 themes and summarised into 5 key findings: (1) emotional management, (2) communication, (3) models of care, (4) environmental factors and resource availability and (5) education. Conclusion The deployment of palliative care in the ICU is affected by elements concerning emotional management, communication practices, care models, resource allocation and staff training. Recommendations include enhancing multidisciplinary teamwork, improving emotional support and communication, optimising resource allocation and providing targeted training for healthcare professionals. Future research should focus on refining palliative care strategies tailored to different clinical environments.