Enhancing Palliative Care Communication in Trauma and Surgical ICU Settings: A Systematic Review.

Introduction

High-quality palliative care in trauma intensive care units is crucial but often hindered by prognostic uncertainty, time constraints, limited provider training, and cultural differences between acute care surgery and palliative care services. In response, the American College of Surgeons Committee on Trauma recommends early goals-of-care discussions for high-risk trauma patients. However, little is known about how these strategies are implemented in practice. We aimed to identify communication strategies in trauma critical care and evaluate their impact on patient and family-centered care.

Methods

We conducted a literature search of PubMed, Embase, CINAHL, and Web of Science for studies published through October 2024. Inclusion criteria focused on adult trauma or surgical ICU patients and studies addressing palliative care, communication strategies, or goals-of-care discussions. Data from eligible studies were extracted and synthesized qualitatively, with themes identified using grounded theory analysis.

Results

We identified 39 eligible studies. Thematic analysis identified five key themes: communication frameworks, interdisciplinary approaches, communication barriers, provider education, and impact on patient and family satisfaction. Communication frameworks including structured family meetings, use of communication checklists, and decision aids such as the Best Case/Worst Case Scenario tool improved shared decision-making. Several studies emphasized the importance of shared responsibility for patients between palliative care specialists and trauma providers.

Conclusions

Evidence suggests that structured communication frameworks and early interdisciplinary involvement improve family satisfaction and patient-centered outcomes. Despite progress, standardized approaches to palliative communication in trauma ICU settings remain a challenge. Future efforts should focus on targeted education and standardized protocols.