Factors Influencing Delayed End-of-Life Care in Critical Care Settings for Adults With Cardiovascular Disease: A...

The aim of this scoping review was to identify factors associated with delayed initiation of end-of-life care for adult patients with cardiovascular disease in critical care settings.

Scoping review.

This scoping review was designed according to the Joanna Briggs Institute methodology. Included articles were uploaded and examined in Covidence.

A systematic search of bibliographic databases (CINAHL, Medline and Embase) and Google Scholar was performed to identify relevant literature between January 2003 and April 2025. Key search concepts included 'end of life', 'cardiac' and 'critical care'.

A total of 9430 articles were initially identified. After removing 7750 irrelevant articles, 207 full-text articles were assessed for eligibility. A total of 34 articles were included in the final review. Four major themes were identified: (1) confidence in communication regarding end of life; (2) transition from active therapies to end-of-life care; (3) role clarity in the initiation and provision of end-of-life care; and (4) breakdown in the shared decision-making process.

Delayed initiation of end-of-life care for patients with cardiovascular disease in critical care settings could be mitigated through training to improve confidence when discussing end of life with patients and families, and utilisation of prognostic prediction assessment tools. Increased focus on inter-professional collaboration and shared decision-making in family meetings may reduce indecision at end of life.

The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

This study did not include patient or public involvement in its design, conduct or reporting.