Stephanie Meddick-Dyson is an Academic Clinical Fellow in Palliative Medicine working in Yorkshire. She trained in acute medicine with intensive care and emergency care experience, developing her clinical and research interest in acute palliative care. Her research, based at the Wolfson Palliative Care Research Centre, focuses on optimising palliative and end-of-life care services in the intensive care unit. Stephanie is co-chair of the End-of-life and Palliative Care in the ICU Research Network (EPCIN), a network she developed to share knowledge and encourage collaboration in the field. Holding high regard for the translation of evidence to practice, Stephanie’s work is underpinned by implementation science. She is working towards helping ICUs successfully implement their complex interventions to provide palliative care, by understanding the implementation factors, and processes involved.
Logic models help conceptualise and manage complexity and can provide a framework for systematic reviews. The Implementation Research Logic Model (IRLM) allows examination of causal pathways and mechanisms enabling implementation. This systematic review aimed to identify and synthesise knowledge on how models of integrating palliative care into the ICU have been implemented, providing critical recommendations for future development and implementation of complex interventions in the field. The IRLM has not yet been used in a systematic review. This study demonstrates the utility of the IRLM as an a priori framework for synthesis.
Standard systematic review methods following PRISMA guidelines. The IRLM was used as an a priori framework for synthesis of intervention characteristics, determinants, implementation strategies, mechanisms, and outcomes reported within effectiveness trials and process evaluations of palliative care interventions in the intensive care unit.
71 effectiveness and/or feasibility studies, and 8 process evaluations referenced 66 interventions. The IRLM provided a clear framework to organise data. Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change headings formed NVivo codes for determinants of implementing palliative care interventions in the Intensive Care Unit (ICU), implementation strategies to address these, and mechanisms for how these strategies lead to change. These codes successfully captured nearly all data. Within included studies, determinants and implementation strategies were widely reported, but implementation mechanisms were not. The IRLM allowed for reporting of relationships between determinants, strategies, and mechanisms, and how these varied with intervention characteristics including ICU type and model of delivery of palliative care.
The IRLM was successfully used to guide a framework synthesis of evidence on implementation of palliative care interventions within ICUs. This methodology could be transferred to other subject areas to systematically review implementation factors. Future work is needed to understand the processes behind these strategies by use of theory.