Co-developing an Implementation Toolkit for Palliative Care in the Intensive Care Unit

Background Palliative and end-of-life care support is essential in Intensive Care Units (ICUs) given symptom burden, mortality rates, and uncertainty.

Variations in palliative care provision, and continuing unmet patient, family, and healthcare professional (HCPs) needs, suggest an evidence-to-practice gap.

Implementation strategies to address barriers to, and facilitators for, palliative care provision in ICUs have been reported. Mechanisms by which reported implementation strategies work are poorly understood.

No guidance exists on how to translate knowledge of implementation factors (barriers, facilitators, strategies) into actionable steps for ICUs to improve palliative care outcomes. Evidence is absent on UK patient and family-perceived implementation factors for ICU palliative care.

This Fellowship Programme will bridge these gaps, creating outputs for practical use, informing ICU palliative care and implementation science research communities.

Aims To provide an evidenced-based, stakeholder and theory-driven, implementation toolkit to facilitate the implementation of standardised evidence-based palliative care interventions relevant to ICU practice. Methods This sequential project comprises three workstreams.

Workstream 1 (Three parts A, B, C) 1A) Patient and family focus groups or interviews Patients and family members of patients who were near death in the ICU will partake in focus groups or individual interviews, based on their preferences.

Their perceived barriers and facilitators to receiving ICU palliative care, and potential implementation strategies to address these, will be explored using validated implementation frameworks. 1B) Healthcare professional interviews using Normalisation Process Theory HCPs with experience delivering or organising ICU palliative care will be interviewed.

Normalisation Process Theory constructs will inform an interview guide, ensuring findings facilitate development and refinement of theoretical understanding of processes behind ICU palliative care implementation. 1C) Expert consensus Delphi study Outputs from focus groups and interviews will be presented alongside evidence from literature to expert HCPs with experience delivering or organising ICU palliative care.

A consensus Delphi study will establish expert consensus on implementation strategies to target with implementation tools.

Workstream 2: Toolkit co-production workshops Patients, families, and HCPs with experience of ICU palliative care will together consider outputs thus far and co-produce implementation toolkit materials.

Workstream 3: Healthcare professional feasibility interviews Multidisciplinary ICU HCPs, including policymakers, in the UK, will be interviewed to validate the acceptability to professionals of the implementation toolkit.

Using a solutions focussed approach, issues and risks to acceptance, adoption and compliance will be worked through to maximise opportunities for embedded use across the system. Impact This programme of work is vital to progress palliative and end-of-life care provision in the ICU.

Creating outputs for practical use and informing ICU palliative care and implementation science research communities to facilitate implementation of evidence-based interventions into practice.

Without, up to 15% of ICU patients, their families, and HCPs caring for them, will continue to have unmet palliative care needs.

Dissemination Outputs will be presented to clinicians and policymakers to influence recommendations for use of the toolkit in practice.

They will be presented at multidisciplinary conferences, published in peer review journals, and shared with HCPs and the public, guided by university communication and dissemination support and PPI members.