Palliative care interventions in intensive care units and their impact on family satisfaction and end-of-life decision-making: systematic review and meta-analysis

Abstract

There are many interventions that focus on communication and palliative care, which have been designed to enhance family-centered outcomes and clinical care, but the overall effectiveness of these interventions is not known. This systematic review and meta-analysis aimed to assess the effects of these interventions on family satisfaction and length of stay (LOS) in the intensive care unit (ICU). A systematic review of studies testing interventions that use communication, family support, or palliative care in adult ICUs was performed. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were used for family satisfaction and ICU LOS. Total 15 studies with over 16,000 patients, family members, and healthcare professionals were included. Structured family meetings, communication facilitators, nurse-led family support programs, palliative care consultations, and communication quality-improvement bundles were used as interventions. There was no statistically significant difference between groups in family satisfaction (MD≤2.65, 95% CI: âˆ'0.56 to 5.85; p≤0.1054) in a meta-analysis of seven studies that included 2,645 participants in intervention groups and 2,717 controls, but family satisfaction was slightly higher in intervention groups. In a pooled analysis of 7 studies, there was no significant difference in ICU LOS (MD≤âˆ'3.40 days, 95% CI: âˆ'7.35 to 0.54; p≤0.0909), although there was a trend toward decreased LOS in the intervention group. Communication-focused and palliative care interventions in ICUs had a positive effect on several dimensions of family-centered care and end-of-life communication but did not lead to significant changes in overall family satisfaction or in the length of stay in the ICU.