Best Evidence Summary: Communication Strategies for Implementing Palliative Care in Adult ICUs

The integration of palliative care in the Intensive Care Unit (ICU) is crucial for mitigating end of life suffering and upholding patient autonomy. However, effective implementation is often hampered by communication challenges. This review aims to synthesise the best evidence on communication strategies to facilitate palliative care in the ICU.

To integrate the best evidence on communication strategies for palliative care in ICU patients and to establish an evidence-based foundation for standardising-related practices in critical care settings.

A systematic search was conducted across multiple databases and platforms including UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), PubMed, Web of Science, Embase, Cochrane Library and CINAHL. Eligible study designs included clinical practice guidelines, evidence summaries, clinical decision support systems, expert consensus publications and systematic reviews related to palliative care communication in the ICU. The search period was from database inception to December 2024. Two independent researchers trained in evidence-based methodology conducted literature screening, quality assessment and evidence synthesis. Standardised appraisal tools were used for critical appraisal.

Fourteen publications were included: three clinical practice guidelines, two evidence-based guidelines and nine systematic reviews. Thirty-four evidence-based recommendations were synthesised across seven key domains: (1) Structured family conferences, (2) Patient value assessment and shared decision-making, (3) Prognostic information disclosure, (4) Written materials and bereavement support, (5) Ethics consultation services, (6) Multidisciplinary team collaboration and (7) Clinician communication training. The evidence hierarchy followed the JBI evidence classification system.

Effective communication strategies encompassing multiple domains are essential for facilitating palliative care in the ICU, addressing the complex needs of critically ill patients and their families.

For clinical practice, this review advocates translating evidence into action by standardising family conferences and integrating multidisciplinary teamwork, thereby enhancing the quality of palliative care communication, respecting patient autonomy and offering sustained support to families in critical care settings.