Transferring patients home to die from intensive care units: A scoping review

A substantial proportion of patients spend their final days in intensive care units (ICUs), where ICU nurses are tasked with providing end-of-life care in critical situations. When patients express a preference to spend their final days at home, direct discharge from the ICU may be appropriate. However, this process presents significant risks and complexities.

The aims of this review were to investigate the prevalence of transfer from ICUs to home and to explore and summarise known facilitators and barriers to this process, as well as its impacts on patients, families, and healthcare systems.

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. MEDLINE via PubMed, CINAHL, PsycINFO, and Igaku Chuo Zasshi (a Japanese local database) were searched for relevant studies published through September 2024, and their characteristics and details were extracted.

A total of 28 studies met the inclusion criteria. The studies were conducted in various countries and included qualitative, quantitative, and mixed-method designs. The intervention procedures related to transferring patients home to die were categorised into seven main areas, including symptom management and palliative care. We identified 21 factors as facilitators of transfer home to die, such as opportunities for consultation with relevant parties, while 11 factors were identified as barriers, with limited local medical resources being the most common. Eleven positive effects were reported, most frequently related to the mental and physical well-being of family members, whereas negative effects included rapid deterioration in the patient's condition.

End-of-life care is influenced by individual beliefs and culture, hospital systems, and the patient's home environment. ICU nurses play an important role as coordinators, intervening early to adjust the environment and support a safe transition home.