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

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While both generalist (primary) palliative care provided at the ICU level and specialist palliative care (SPC) services support delivery, there is limited clarity regarding how such integration and care can be measured. Key performance indicators are generally identified as indicators of the quality of healthcare. However, relevant palliative care key performance indicators for the ICU are poorly defined and vary across policies, regulations, and the literature. Aim To identify and map key performance indicators to inform a domain-based framework for evaluating palliative care delivery in ICUs. Methods This study will be conducted as a scoping review following the PRISMA-ScR guidelines. We will undertake a systematic search of peer-reviewed records, grey literature, national health system sources, regulatory bodies, and professional organisations. Once extracted, we will analyse the key performance indicators and group them into domains reflecting both generalist and specialist palliative care delivery. Conclusions This will result in a comprehensive synthesis of key performance indicators and inform the development of a structured framework to support the evaluation and implementation of palliative care delivery in the ICU. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/9-44/v1", "name": "Mapping of key performance indicators for palliative care in intensive..." } } ] } Home Browse Mapping of key performance indicators for palliative care in intensive... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article King Y, May P and Brady AM. Mapping of key performance indicators for palliative care in intensive care settings: A scoping review protocol [version 1; peer review: awaiting peer review] . HRB Open Res 2026, 9 :44 ( https://doi.org/10.12688/hrbopenres.14430.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Mapping of key performance indicators for palliative care in intensive care settings: A scoping review protocol [version 1; peer review: awaiting peer review] Yvonne King https://orcid.org/0000-0002-4509-2645 1 , Peter May 2,3 , Anne-Marie Brady 1 Yvonne King https://orcid.org/0000-0002-4509-2645 1 , Peter May 2,3 , Anne-Marie Brady 1 PUBLISHED 30 Apr 2026 Author details Author details 1 Trinity Centre for Practice & Healthcare Innovation,School of Nursing and Midwifery, Trinity College Dublin,The University of Dublin, Dublin, Leinster, Ireland 2 Cicely Saunders Institute of Palliative Care Policy & Rehabilitation,Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, England, UK 3 School of Medicine, Trinity College Dublin, Trinity College Dublin, Dublin, Leinster, Ireland Yvonne King Roles: Conceptualization, Funding Acquisition, Visualization, Writing – Original Draft Preparation Peter May Roles: Supervision, Writing – Review & Editing Anne-Marie Brady Roles: Supervision, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW Abstract Background Palliative care integration in intensive care units (ICUs) is becoming increasingly important in terms of patient-centred care delivery. While both generalist (primary) palliative care provided at the ICU level and specialist palliative care (SPC) services support delivery, there is limited clarity regarding how such integration and care can be measured. Key performance indicators are generally identified as indicators of the quality of healthcare. However, relevant palliative care key performance indicators for the ICU are poorly defined and vary across policies, regulations, and the literature. Aim To identify and map key performance indicators to inform a domain-based framework for evaluating palliative care delivery in ICUs. Methods This study will be conducted as a scoping review following the PRISMA-ScR guidelines. We will undertake a systematic search of peer-reviewed records, grey literature, national health system sources, regulatory bodies, and professional organisations. Once extracted, we will analyse the key performance indicators and group them into domains reflecting both generalist and specialist palliative care delivery. Conclusions This will result in a comprehensive synthesis of key performance indicators and inform the development of a structured framework to support the evaluation and implementation of palliative care delivery in the ICU. READ ALL READ LESS Keywords Critical Care; End-of-Life Care; Intensive Care Units; Key Performance Indicators, Palliative Care; Quality Indicators, Scoping Reviews Corresponding Author(s) Yvonne King ( [email protected] ) Close Corresponding author: Yvonne King Competing interests: No competing interests were disclosed. Grant information: This work was supported by the Irish Research Council [GOIPG/2020/372, 2020]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2026 King Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: King Y, May P and Brady AM. Mapping of key performance indicators for palliative care in intensive care settings: A scoping review protocol [version 1; peer review: awaiting peer review] . HRB Open Res 2026, 9 :44 ( https://doi.org/10.12688/hrbopenres.14430.1 ) First published: 30 Apr 2026, 9 :44 ( https://doi.org/10.12688/hrbopenres.14430.1 ) Latest published: 30 Apr 2026, 9 :44 ( https://doi.org/10.12688/hrbopenres.14430.1 ) Introduction Integrating palliative care into intensive care units (ICU) is a growing priority in international policy and clinical guidance ( Centre of Advanced Palliative Care [CAPC], 2019 ; Kesecioglu et al. 2018 ; World Health Organisation [WHO], 2014 ). Patients in the ICU are older and face a high symptom burden, complex decisions, and uncertain outcomes, requiring clinicians to provide generalist palliative care and seek specialist support as needed ( Akinosoglou et al., 2023 ; Giabicani et al. 2023 ; Hua et al. 2014 ). Evidence indicates that early palliative care, integrated alongside active treatment beyond end-of-life care, facilitates timely identification of patient needs, enhances decision-making and quality of patient centred care ( Araujo et al., 2023 ; Aslakson et al., 2014 ; Ma et al., 2019 ) . Despite this, there is no standardised way to measure the quality or effectiveness of palliative care integration or delivery in ICU settings. Key performance indicators (KPIs) are widely used across healthcare to support quality improvement, benchmarking, and accountability ( WHO, 2018 ). However, indicators relevant to ICU palliative care remain varied across policy documents, regulatory standards, and academic literature, resulting in limited synthesis and little conceptual clarity, limiting their application in practice, quality improvement, and system-level evaluation. This study builds on our previous work, which mapped key palliative care characteristics of ICU integration models, by translating these into a structured framework of measurable indicators to support system-level evaluation ( King Y. et al. 2026 ). It supports national research priorities in Ireland by outlining how palliative care delivery can be measured and evaluated for individuals with life-limiting illness ( All Ireland Institute of Hospice and Palliative Care [AIIHPC], 2025 ). A scoping review is appropriate for identifying and mapping this diverse evidence base ( Peters et al., 2020 ). These findings will inform the development of an evidence-based KPI framework to support quality improvement, benchmarking, and accountability in ICU palliative care. Protocol Study design: This scoping review will be conducted in accordance with the methodological framework proposed by Arksey and O’Malley (2005) , with additional guidance from the Joanna Briggs Institute, and will be reported in line with the PRISMA-ScR guidelines. Aim : To identify and map key performance indicators (KPIs) to inform a framework for evaluating palliative care delivery in intensive care units (ICUs). Objectives 1. To identify KPIs used to evaluate palliative care delivery in ICUs. 2. To map the domains and categories of these indicators. 3. To examine how these indicators are defined and measured across studies. 4. To inform the development of a structured framework that organises domains and KPIs for evaluating palliative care delivery in the ICU Table 1 details the Population, Concept, and Context (PCC). Table 1. Population, Concept, and Context (PCC) framework guiding the review. Population Concept Context Adult patients in ICU KPIs, quality measures & outcome measures Delivery & integration of palliative care in ICU settings * ICU = Intensive Care Unit; KPIs = Key Performance Indicators. 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. Table 2. Key concepts used to inform the search strategy. Concept Content #1 Palliative care #2 ICU/critical care #3 KPIs/quality indicators * ICU = Intensive Care Unit; KPIs = Key Performance Indicators. Table 3. Information sources to be searched, including databases and grey literature sources. Source type Sources Bibliographic databases MEDLINE, CINAHL, Embase International organisations World Health Organisation (WHO), European Association for Palliative Care (EAPC) Policy and guideline bodies National Institute for Health and Care Excellence (NICE), Health Information and Quality Authority (HIQA), Department of Health (Ireland) National health systems Health Service Executive (HSE, Ireland) Professional organisations All Ireland Institute of Hospice and Palliative Care (AIIHPC); Intensive Care Society (UK & Ireland); Society of Intensive Care Medicine (Ireland); American Thoracic Society (USA); Australian and New Zealand Intensive Care Society (ANZICS) Research and policy groups Center to Advance Palliative Care (CAPC), Robert Wood Johnson Foundation workgroups Clinical programmes National Clinical Programme for Palliative Care (Ireland) 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. Table 4. Inclusion and exclusion criteria for study selection. Inclusion Exclusion Studies and documents describing: • KPIs • quality indicators • outcome measures Related to: • palliative care • ICU/critical care Sources: • peer-reviewed literature • national policy • regulatory frameworks • audit reports • grey literature • Non-ICU settings • Paediatric ICU settings only • Opinion pieces • Abstracts • Non-peer reviews • >10 years old • Publications where “palliative care” is not explicitly mentioned * ICU = Intensive Care Unit 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. Table 5. Data extraction variables for charting included studies. Category Variable Description/Purpose Study Characteristics Author(s) First author and year of publication Year of publication (2014-present) To ensure clinical and policy relevance Country/region Geographic context of study Study design e.g. qualitative, quantitative, mixed-methods, policy document ICU setting Type of ICU (e.g. medical, surgical, mixed, specialist ICU) Concept Type of palliative care delivery Generalist vs specialist palliative care; model of integration within ICU Domain of care Physical, psychological, social, spiritual, end-of-life care Indicators/KPIs Indicator name Name/label of KPI or quality indicator Indicator definition How the indicator is defined Indicator type Structure, process, or outcome measure Measurement method How the indicator is measured (e.g. audit, tool, scale) Data source e.g. patient records, ICU databases, administrative data Timing of measurement When indicator is assessed (e.g. ICU admission, during stay, end-of-life) Implementation/Use Purpose of indicator Quality improvement, benchmarking, audit, policy Level of application Patient-level, ICU/unit-level, system-level Feasibility/usability Reported facilitators or challenges to use in ICU Key Findings Main findings Summary of relevant results Recommendations Author recommendations for ICU palliative care practice/policy Relevance to Review Relevant to framework development Role in informing palliative care ICU KPI framework * ICU = Intensive Care Unit; KPIs = Key Performance Indicators 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. Conclusion This scoping review will map available evidence and policies on KPIs for ICU palliative care. It will clarify these PC KPIs for ICU care and their application. The review will address an important gap in the literature and support the development of an evidence-based KPI framework. These findings are expected to inform clinical practice, quality improvement initiatives, and policy development, enhancing the integration and evaluation of palliative care in ICU settings. Patient and public involvement Patients and the public were not involved in the design of this protocol. Ethics and consent Ethical approval is not required as the study involves analysis of publicly available data. Dissemination Findings will be disseminated through peer-reviewed publication, conference presentations, and engagement with policy and clinical stakeholders. The resulting framework aims to support evaluation and implementation of integrated palliative care within ICU settings. Registration : The protocol has been registered on the Open Science Framework (OSF) ( https://osf.io/w5j8v/ ). Study status: The study is currently at the development stage. Data availability statement No data associated with this article. Extended data Open Science Framework (OSF). https://doi.org/10.17605/OSF.IO/W5J8V ( King Y. et al. 2026 ). Relevant study materials (e.g., collection tools, and supplementary documentation) will be developed during the study and deposited in this file. This project contains the following underlying data: • Search string • PRISMA-ScR Checklist. Data is available under the terms of the CC-By Attribution 4.0 International . Reference Akinosoglou K, Schinas G, Almyroudi MP, et al. : The impact of age on intensive care. Ageing Res. Rev. 2023; 84 : 101832. PubMed Abstract | Publisher Full Text | Free Full Text All Ireland Institute of Hospice and Palliative Care (AIIHPC): Top ten all Ireland research priorities for palliative and end-of-life care launched.2025. (accessed on 22/03/26). Reference Source Aslakson RA, Curtis JR, Nelson JE: The changing role of palliative care in the ICU. Crit. Care Med. 2014; 42 : 2418–2428. PubMed Abstract | Publisher Full Text | Free Full Text Araujo MCR, da Silva DA , Wilson AMMM: Nursing interventions in palliative care in the intensive care unit: A systematic review. Enferm. Intensiva. 2023; 34 : 156–172. Publisher Full Text Arksey H, O’Malley L: Scoping studies: Towards a methodological framework. Int. J. Soc. Res. Methodol. 2005; 8 : 19–32. Publisher Full Text Braun V, Clarke V: Thematic Analysis: A Practical Guide. London: Sage; 2021. CAPC, Learning, MCookbook, R: IPAL-ICU Reference library.June 2019. (n.d.) Darmon M, Azoulay E: European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. Intensive Care Med. 2024; 50 , 10 : 1740–1766. PubMed Abstract | Publisher Full Text | Free Full Text Giabicani M, Arditty L, Mamzer M-F, et al. : Team-family conflicts over end-of-life decisions in ICU: A survey of French physicians' beliefs. PloS one. 2023; 18 (4). PubMed Abstract | Publisher Full Text | Free Full Text Hua MS, Li G, Blinderman CD, et al. : Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am. J. Respir. Crit. Care Med. 2014; 189 (4): 428–436. PubMed Abstract | Publisher Full Text | Free Full Text Kesecioglu J, Rusinova K, Alampi D, et al. : European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unitSociety f Critical Care Medicine; Clinical practice guidelines for primary palliative care in the ICU. . Intensive Care Med. 2024; 50(11):1740-1766. doi: 10.1007/s00134-024-07579-1. Epub 2024 Oct 3. PMID: 39361081; PMCID: PMC11541285. King Y, Dr Brady A-M , Dublin TC, et al. : Protocol: Mapping of key performance indicators for palliative care in intensive care Units: A scoping review.2026, April 14. Publisher Full Text Ma J, Chi S, Buettner B, et al. : Early palliative care consultation in the medical ICU: A cluster randomized crossover trial. Crit. Care Med. 2019; 47 (12): 1707–1715. PubMed Abstract | Publisher Full Text | Free Full Text Peters MDJ, Marnie C, Tricco AC, et al. : Updated methodological guidance for the conduct of scoping reviews. JBI Evidence. Synthesis. 2020; 18 (10): 2119–2126. Publisher Full Text World Health Organisation: National cancer control programmes: Policies and managerial guidelines. World Health Organisation; 2nd ed.2002. World Health Organisation & Worldwide Hospice Palliative Care Alliance: Global Atlas of Palliative Care at the End of Life. Worldwide Hospice Palliative Care Alliance; 2014. (accessed on 02/04/26). Reference Source World Health Organisation, Organisation for Economic Co-operation and Development, & The World Bank: Delivering quality health services: A global imperative for universal health coverage. World Health Organisation; 2018. (accessed on 02/04/26). Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 30 Apr 2026 ADD YOUR COMMENT Comment Author details Author details 1 Trinity Centre for Practice & Healthcare Innovation,School of Nursing and Midwifery, Trinity College Dublin,The University of Dublin, Dublin, Leinster, Ireland 2 Cicely Saunders Institute of Palliative Care Policy & Rehabilitation,Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, England, UK 3 School of Medicine, Trinity College Dublin, Trinity College Dublin, Dublin, Leinster, Ireland Yvonne King Roles: Conceptualization, Funding Acquisition, Visualization, Writing – Original Draft Preparation Peter May Roles: Supervision, Writing – Review & Editing Anne-Marie Brady Roles: Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by the Irish Research Council [GOIPG/2020/372, 2020]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 30 Apr 2026, 9:44 https://doi.org/10.12688/hrbopenres.14430.1 Copyright © 2026 King Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article King Y, May P and Brady AM. Mapping of key performance indicators for palliative care in intensive care settings: A scoping review protocol [version 1; peer review: awaiting peer review] . 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