Integration of Palliative Care in Intensive Care Units: Models, Interventions, and Implementation Challenges: A Narrative Review

Abstract

Context: Palliative care plays an important and vital role in reducing pain and suffering among patients receiving treatment in critical care settings. This narrative review was conducted in 2025 with the aim of reviewing the existing evidence on models, interventions, and challenges associated with implementing palliative care in the intensive care unit (ICU). Evidence Acquisition: This study was a narrative review of the existing evidence regarding interventions, models, and outcomes of palliative care in adult ICU patients. Between January 2010 and July 2025, an extensive literature search was performed across databases including PubMed, Scopus, Embase, Web of Science, Google Scholar, Magiran, Irandoc, and SID. Eligible studies included peer-reviewed publications focusing on palliative care in the ICU for populations aged ≥ 18 years, published in English or Persian. Following screening and quality assessment, 19 articles were included in the final analysis. Results: Among the 19 selected studies (7 narrative reviews with expert consensus, 2 narrative reviews, 2 systematic reviews with meta-analysis, 3 systematic reviews, 3 interventional studies, and 1 mixed-methods study), two primary models of ICU palliative care integration were identified: The consultative model and the integrative model. The success of these approaches depended on specialized training for nurses and physicians, standardized protocols, and interprofessional collaboration, although a lack of training and resources remained a significant challenge. The use of appropriate screening criteria and triggers can enhance access to and the quality of palliative care in the ICU. Conclusions: Palliative care in the ICU, whether through an integrative or consultative model, improves care quality, alleviates physical and psychological symptoms in critically ill patients, increases family satisfaction, and optimizes resource utilization. Nurses play a central role in delivering these interventions, and specialized training, standardized protocols, and interprofessional collaboration are prerequisites for their successful implementation. Palliative care should be an integral part of the management of all critically ill patients, not solely end-of-life care, and evidence-based policymaking along with the development of a supportive organizational culture facilitates its implementation.