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Clinical practice

Aspects of Communication in Provision of Palliative Care around the World


August 2023 | Clinical practice | Communication skills | Healthcare around the World | Research

Effendy, C., Yodang, Y., Amalia, S., Rochmawati, E. (2022). Barriers and facilitators in the provision of palliative care in adult intensive care units: a scoping review. Acute and Critical Care, November, 37(4): 516-526

What this research was about and why it is important

The researchers from Indonesia highlighted the increasing significance of provision of palliative care (PPC) in an adult intensive care unit (ICU) in the last decade. The aim of their study was to explore and synthesise research studies that identify barriers and also facilitators in PPC in the ICU. In their review article, they present a table which includes information about 14 studies from various countries around the world. This analysis focused on the quality and scope of knowledge and training in communication skills of the healthcare professionals, previous experience of working with terminally ill patients, motivation and support from colleagues at workplace as well as cultural differences, and communication with family related to dying and grieving.

 What the researchers did

  • They analysed 14 studies published in English between 2005-2021 in Scopus, PubMed, ProQuest, Science Direct, and Sage databases.
  • The studies were conducted in 9 countries: Egypt (1), United States (5), Brazil (2), Israel (1), Germany (1), Canada (1), Poland (1), Scotland (1), and Jordan (1).
  • In a form of a table, they provided the following information about each study: (1) author and year of publication; (2) aim of the study; (3) context of the study (country, type of ICU); (4) study design; (5) respondents (number of participants, characteristics) and (6) study findings.
  • The researchers applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines and followed the methodology for conducting a scope review by Arksey and O´Maley´s.

What the researchers found

  • The barriers included lack of capabilities (knowledge, skills, communication), family boundaries, practical issues, and cultural differences.
  • The facilitators included greater experience and supportive behaviours, i. e. collaboration between healthcare professionals, for example, transformational leadership and peer emotional support.
  • The literature review showed a lack of education and training in communication skills when dealing with patients and families, specifically-related to decision-making by doctors and nurses.
  • Inadequate knowledge and training were also revealed in relation to the communication skills of healthcare professionals when interacting with a grieving family and the quality of end-of-life care (symptom management) provided.
  • Another issue was the little experience and contact healthcare professionals had with dying patients.
  • Comparison of cultures pointed to a lack of awareness of ethical issues and the culture of the heroic idea of “fighting till the end”.

 Things to consider

  • Data on implementation of PC in the ICU settings is missing due to the common practice of referring PC patients to hospice care, which is mostly offered in a non-hospital setting.
  • The literature search found a limited number of studies focusing on the barriers and facilitators of palliative care integration in the ICU.


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