Medical competencies in palliative care for the intensive care physician

: a scoping review

Abstract

Introduction: Intensive Care Medicine provides life support during potentially reversible critical illness, but Intensive Care Units have a high prevalence of death and suffering. The integration of palliative care in Critical Care Medicine is recommended but the medical palliative competencies required for the practice of the intensive care physician remain to be determined. The aim of this scoping review is to identify and list the medical competencies in palliative care that have been considered relevant for the practice of Intensive Care Medicine. Methodology: Participant studies concern populations which include physicians specialized in Critical Care Medicine or working in Intensive Care Units and focus on the concept of generalist palliative competencies relevant for the practice of intensive care medicine. Studies reporting on Neonatal and Pediatric Intensive Care, concerning pre graduate training and those focusing on medical assistance in dying were excluded. Following JBI methodology for scoping reviews, a comprehensive search was performed on the 19th of December 2019, in PubMED and CINAHL databases and grey literature. The search was limited to English, Portuguese, French and Spanish languages, with no time limits. Study selection was performed by two independent reviewers and conflicts were resolved through consensus or by a third reviewer. Data extraction included the identification and characterization of the studies and the listing of the competencies described, using an Excel sheet. Results: Of the initial 7449 citations, 57 articles met the eligibility criteria, yielding 941 competency statements. These were categorized in 9 domains of palliative care: 1. Apply the core constituents of palliative care in the setting where patients and families are based; 2. Patient and family-centered decision-making; 3. Communication within the team and with patients and families; 4. Continuity of care; 5. Emotional and practical support for patients and families; 6. Symptom management and comfort care; 7. Spiritual support for patients and families; 8. Emotional and organizational support for ICU clinicians and 9. Self-awareness and continuing professional development. Elimination of duplicates and grouping resulted in a final set of 392 competencies. Conclusions: The integration of palliative care in the treatment of critically ill patients has been a focus of interest of the medical literature but significant gaps remain. Future research should focus on the identification of appropriate assessment methods for the competencies that are required to improve patient and family outcomes.

Date of Award	21 Jul 2022
Original language	English
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Manuel Luís Capelas (Supervisor)