Mapping of key performance indicators for palliative care in intensive care settings: A scoping review protocol

Objectives

Table 1 details the Population, Concept, and Context (PCC).

Search strategy: We will conduct a comprehensive search using controlled vocabulary (e.g., MeSH terms) and free-text terms derived from the PCC framework. The search will focus on three core concepts: palliative care, intensive care, and key performance or quality indicators (see Table 2). The full search string for all databases is available on the Open Science Framework (OSF) at 10.17605/OSF.IO/W5J8V We will combine synonymous terms using OR operator within each key concept to maximise search sensitivity. Core concepts will then be combined using the AND operator. Truncation and phrase searching will capture variations within terminology. There is no single index term for key performance indicators, so we will use a mix of subject headings and free-text terms. These will include quality indicators, outcomes, audit, benchmarking, and improvement. We will search MEDLINE, CINAHL, and Embase. See Table 3 for full details. Initially, we will search all years, then apply a date limit from 2014 onward. The date limit is justified by the shift towards integrated palliative care in contemporary acute healthcare policy. This builds on earlier WHO guidance that positioned palliative care alongside active treatment (WHO, 2002; WHO & Worldwide Hospice Palliative Care Alliance, 2014). We will identify relevant indicators by systematically searching the named databases and grey literature from national health systems, regulatory bodies, and professional organisations. This search process will be documented and reported using a PRISMA-ScR flow diagram.

Eligibility criteria: We developed the eligibility criteria using the PCC structure to guide study selection. This strategy will include studies and documents relating to adult patients (≥18 years) receiving care in ICU settings, also known as critical care settings. We plan to exclude studies focusing on paediatric populations. This review focuses on key performance indicators (KPIs), quality indicators, and outcome measures relevant to palliative care, within adult ICUs. This includes indicators relating to quality of care, service delivery, clinical processes, patient or family outcomes, and audit and benchmarking. Applying limits to the last 12 years ensure relevancy to today’s practice.

Study selection: Titles and abstracts will be screened against inclusion criteria, followed by full-text review. Table 4 shows the inclusion/exclusion criteria. Screening will be conducted by two reviewers with discrepancies resolved through discussion with a third arbitrator.

Data extraction & charting: We will extract data using a standardised charting form, detailed in Table 5. Planned extraction data include study characteristics (authors, year of publication, country/region, and study design) and ICU type (e.g., medical, surgical, or mixed intensive care units). Planned extracted data include the type of palliative care delivered (e.g., generalist or specialist modes) and the domains of care (physical, psychological, social, spiritual, and end-of-life). For each identified KPI, we will record name, definition, type (structure, process, or outcome), measurement methods, data sources, and the timing of measurement during an ICU stay.

We also plan to extract the purpose and application of the identified KPIs. (e.g., quality improvement, benchmarking, audit), the level of implementation (patient, unit, or system level), and any documented facilitators or challenges to them. Finally, key findings and recommendations relevant to ICU palliative care will be documented, including their relevance to the development of a KPI framework. This data will support the interpretation of the relevance, applicability, and feasibility of the identified KPIs and inform the identification of meaningful, implementable indicators for inclusion in the proposed KPI framework. We plan to pilot a sample of included studies and refine this chart iteratively to ensure consistency and relevance. Data will be extracted by one reviewer and independently checked for accuracy by a second reviewer.

Data synthesis: Extracted KPIs will be analysed using an, inductive iterative thematic analysis approach to identify key domains and patterns (Braun & Clarke, 2021). Indicators will be grouped into domains reflecting core components of palliative care delivery and integration within ICU settings.

We plan to capture both generalist (primary) palliative care and specialist palliative care concepts, indicators and domains within ICU practice.

Results: We will provide a descriptive summary of the identified KPIs, including their categorisation into domains and themes. The findings will be mapped against the review objectives to provide an overview of the types of indicators used to evaluate palliative care delivery in ICUs. We will develop a conceptual framework that organises identified domains and KPIs, and classify KPIs according to the Donabedian Model (structure, process, and outcomes) to support system-level evaluation.

Potential limitations of this scoping review will be acknowledged, including restrictions on study design, reporting quality, and the absence of a formal quality appraisal. As this review aims to map KPIs for evaluating palliative care delivery within the ICU, we will include studies regardless of methodological design or quality to ensure comprehensive coverage. This is consistent with guidance from the Joanna Briggs Institute and others, which emphasises that critical appraisal in scoping reviews should be guided by the review objectives (Arksey & O’Malley, 2005; Peters et al., 2020). Limitations related to the breadth of the search and potential gaps in the available evidence will also be considered.

The findings of this review will inform the development of a framework for evaluating palliative care delivery in ICUs and identify gaps in the existing evidence base to guide future research and practice.