TY - JOUR

T1 - Stakeholder Engagement as a Strategy to Enhance Palliative Care Involvement in Intensive Care Units

T2 - A Theory of Change Approach

AU - Rao, Seema

AU - Salins, Naveen

AU - Remawi, Bader

AU - Rao, Shwetapriya

AU - Shanbaug, Vishal

AU - Arjun, N.R

AU - Bhat, Nitin

AU - Shetty, Rajesh

AU - Karanth, Sunil

AU - Gupta, Vivek

AU - Jahan, Nikahat

AU - Setlur, Rangraj

AU - Simha, Srinagesh

AU - Walshe, Catherine

AU - Preston, Nancy

PY - 2023/6/30

Y1 - 2023/6/30

N2 - BackgroundAdult patients admitted to intensive care units in the terminal phase experience high symptom burden, increased costs, and diminished quality of dying. There is limited literature on palliative care engagement in ICU, especially in lower-middle-income countries. This study explores a strategy to enhance palliative care engagement in ICU through a stakeholder participatory approach.MethodsTheory of Change approach was used to develop a hypothetical causal pathway for palliative care integration into ICUs in India. Four facilitated workshops and fifteen research team meetings were conducted virtually over three months. Thirteen stakeholders were purposively chosen, and three facilitators conducted the workshops. Data included workshop discussion transcripts, online chat box comments, and team meeting minutes. These were collected, analysed and represented as theory of change map.ResultsThe desired impact of palliative care integration was good death. Potential long-term outcomes identified were fewer deaths in ICUs, discharge against medical advice, and inappropriate admissions; increased referrals to palliative care; and improved patient and family satisfaction. Twelve preconditions were identified, and eleven key interventions were developed. Five overarching assumptions related to contextual factors influencing the outcomes of interventions.ConclusionTheory of change framework facilitated the identification of proposed mechanisms and interventions underpinning palliative care integration in ICUs.

AB - BackgroundAdult patients admitted to intensive care units in the terminal phase experience high symptom burden, increased costs, and diminished quality of dying. There is limited literature on palliative care engagement in ICU, especially in lower-middle-income countries. This study explores a strategy to enhance palliative care engagement in ICU through a stakeholder participatory approach.MethodsTheory of Change approach was used to develop a hypothetical causal pathway for palliative care integration into ICUs in India. Four facilitated workshops and fifteen research team meetings were conducted virtually over three months. Thirteen stakeholders were purposively chosen, and three facilitators conducted the workshops. Data included workshop discussion transcripts, online chat box comments, and team meeting minutes. These were collected, analysed and represented as theory of change map.ResultsThe desired impact of palliative care integration was good death. Potential long-term outcomes identified were fewer deaths in ICUs, discharge against medical advice, and inappropriate admissions; increased referrals to palliative care; and improved patient and family satisfaction. Twelve preconditions were identified, and eleven key interventions were developed. Five overarching assumptions related to contextual factors influencing the outcomes of interventions.ConclusionTheory of change framework facilitated the identification of proposed mechanisms and interventions underpinning palliative care integration in ICUs.

KW - Intensive care

KW - Palliative care

KW - Theory of change

KW - India

KW - Causal pathway

KW - Lower- and middle-income countries

U2 - 10.1016/j.jcrc.2022.154244

DO - 10.1016/j.jcrc.2022.154244

M3 - Journal article

VL - 75

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

M1 - 154244

ER -