Palliative and end-of-life care in intensive care units in low- and middle-income countries: A systematically constructed scoping review

ElsevierVolume 71, October 2022, 154115Journal of Critical CareHighlights•

Most palliative care research in ICUs has been conducted in Western, high income countries.

The care context in low- and middle-income countries may influence the relevance of research findings from elsewhere.

No research on palliative care in ICUs in low- and middle- income countries explores the patient perspective directly

Key topics include withdrawing treatment; professional knowledge; patient views; culture and context; and costs of care

AbstractPurpose

Death is common in intensive care units, and integrating palliative care enhances outcomes. Most research has been conducted in high-income countries. The aim is to understand what is known about the type and topics of research on the provision of palliative care within intensive care units in low- and middle-income countries

Materials and methods

Scoping review with nine databases systematically searched for literature published in English on palliative care in intensive care units in low- and middle- income settings (01/01/1990 to 31/05/2021). Two reviewers independently checked search results and extracted textual data, which were analyzed and represented as themes.

Results

Thirty papers reported 19 empirical studies, two clinical case reports and six discussion papers. Papers originated from Asia and Africa, primarily using observational designs and qualitative approaches, with no trials or other robust evaluative or comparative studies. No studies directly sought data from patients or families. Five areas of research focus were identified: withholding and withdrawing treatment; professional knowledge and skills; patient and family views; culture and context; and costs of care.

Conclusions

Palliative care in intensive care units in low-and middle-income countries is understudied. Research focused on the specific needs of intensive care in low- and middle-income countries is required to ensure optimal patient outcomes.

Keywords

Palliative care

Terminal care

End of life care

Intensive care units

Developing countries

Asia

Africa

© 2022 The Authors. Published by Elsevier Inc.

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