{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:09:39Z","timestamp":1788858579960,"version":"build-2803163510"},"update-to":[{"DOI":"10.12688\/hrbopenres.14430.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000}}],"reference-count":16,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002081","name":"Irish Research Council","doi-asserted-by":"publisher","award":["GOIPG\/2020\/372"],"award-info":[{"award-number":["GOIPG\/2020\/372"]}],"id":[{"id":"10.13039\/501100002081","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002081","name":"Irish Research Council","doi-asserted-by":"publisher","award":["2020"],"award-info":[{"award-number":["2020"]}],"id":[{"id":"10.13039\/501100002081","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"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.<\/ns3:p>","DOI":"10.12688\/hrbopenres.14430.2","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T05:29:08Z","timestamp":1786166948000},"page":"44","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mapping of key performance indicators for palliative care in intensive care settings: A scoping review protocol"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4509-2645","authenticated-orcid":false,"given":"Yvonne","family":"King","sequence":"first","affiliation":[{"name":"Trinity Centre for Practice & Healthcare Innovation,School of Nursing and Midwifery Dublin Leinster Trinity College Dublin,The University of Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"May","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute of Palliative Care Policy & Rehabilitation,Florence Nightingale Faculty of Nursing Midwifery & Palliative Care London England King's College London"},{"name":"School of Medicine Dublin Leinster Trinity College Dublin, Trinity College Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Brady","sequence":"additional","affiliation":[{"name":"Trinity Centre for Practice & Healthcare Innovation,School of Nursing and Midwifery Dublin Leinster Trinity College Dublin,The University of Dublin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"101832","DOI":"10.1016\/j.arr.2022.101832","article-title":"The impact of age on intensive care.","volume":"84","author":"K Akinosoglou","year":"2023","journal-title":"Ageing Res. Rev."},{"key":"ref2","article-title":"Top ten all Ireland research priorities for palliative and end-of-life care launched.","year":"2025"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2418-2428","DOI":"10.1097\/CCM.0000000000000573","article-title":"The changing role of palliative care in the ICU.","volume":"42","author":"R Aslakson","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"156-172","DOI":"10.1016\/j.enfi.2022.04.002","article-title":"Nursing interventions in palliative care in the intensive care unit: A systematic review.","volume":"34","author":"M Araujo","year":"2023","journal-title":"Enferm. Intensiva."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"19-32","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: Towards a methodological framework.","volume":"8","author":"H Arksey","year":"2005","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e529-e543","DOI":"10.1016\/j.jpainsymman.2021.12.031","article-title":"International standards for pediatric palliative care: From IMPaCCT to GO-PPaCS.","volume":"63","author":"F Benini","year":"2022","journal-title":"J. Pain Symptom Manage."},{"key":"ref7","article-title":"IPAL-ICU Reference library.","year":"June 2019"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1740-1766","DOI":"10.1007\/s00134-024-07579-1","article-title":"European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.","volume":"50","author":"M Darmon","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1743-1748","DOI":"10.1001\/jama.260.12.1743","article-title":"The quality of care: How can it be assessed?","volume":"260","author":"A Donabedian","year":"1988","journal-title":"JAMA."},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0284756","article-title":"Team-family conflicts over end-of-life decisions in ICU: A survey of French physicians' beliefs.","volume":"18","author":"M Giabicani","year":"2023","journal-title":"PloS one."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1277-1288","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis.","volume":"15","author":"H Hsieh","year":"2005","journal-title":"Qual. Health Res."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"428-436","DOI":"10.1164\/rccm.201307-1229OC","article-title":"Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model.","volume":"189","author":"M Hua","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref11","article-title":"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.","author":"J Kesecioglu","journal-title":""},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.17605\/OSF.IO\/W5J8V","article-title":"Protocol: Mapping of key performance indicators for palliative care in intensive care Units: A scoping review.","author":"Y King","year":"2026, April 14"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1707-1715","DOI":"10.1097\/CCM.0000000000004016","article-title":"Early palliative care consultation in the medical ICU: A cluster randomized crossover trial.","volume":"47","author":"J Ma","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2119-2126","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated methodological guidance for the conduct of scoping reviews.","volume":"18","author":"M Peters","year":"2020","journal-title":"JBI Evid. Synth."}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:34:09Z","timestamp":1788856449000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,8]]},"references-count":16,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.14430.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/hrbopenres.14430.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.16009.r57341","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.16009.r57116","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.16009.r57116","asserted-by":"object"},{"id-type":"doi","id":"10.21956\/hrbopenres.16009.r57341","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,8]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.16009.r57116, Michael Bennett, University of Windsor, Windsor, 11 Aug 2026, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2#referee-response-57116","order":0,"name":"referee-response-57116","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15899.r55767, Jude Ominyi, University of Suffolk, Ipswich, 22 Jun 2026, version 1, 2 approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v1#referee-response-55767","order":1,"name":"referee-response-55767","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Yvonne King<\/b>; \nPosted: 30 Jul 2026<\/i>; Dear Dr Jude, Ominyi, Thank you for taking the time to review our protocol and for your helpful suggestions. We appreciate your thoughtful and constructive comments, which have helped strengthen the protocol. Please find our responses to your comments below. \nComment 1<\/b>\n: \u201cClarify whether the study is solely a scoping review or also includes formal framework development and specify the methodology for framework construction if intended\u201d.<\/i> \nResponse<\/b>: We have revised the manuscript to clarify that this study is a scoping review and does not include a formal framework development methodology. The primary purpose of the review is to identify, map, and synthesise key performance indicators (KPIs) relating to palliative care delivery in ICU settings. The identified KPIs will be organised into a preliminary, evidence-informed domain-based framework derived from the mapped evidence to support interpretation of the findings and inform future framework refinement and validation. We have also clarified that this represents an organising structure rather than a formally developed or validated evaluation framework. In addition, we specify that the identified KPIs will be classified using the established Donabedian Model (structure, process, and outcome) to support the organisation and interpretation of the finding.","URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2#referee-comment-3953","order":2,"name":"referee-comment-3953","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Yvonne King<\/b>; \nPosted: 30 Jul 2026<\/i>; Dear Dr Jude, Ominyi, Thank you for taking the time to review our protocol and for your helpful suggestions. We appreciate your thoughtful and constructive comments, which have helped strengthen the protocol. Please find our responses to your comments below. \nComment 1<\/b>\n: \u201cClarify whether the study is solely a scoping review or also includes formal framework development and specify the methodology for framework construction if intended\u201d.<\/i> \nResponse<\/b>: We have revised the manuscript to clarify that this study is a scoping review and does not include a formal framework development methodology. The primary purpose of the review is to identify, map, and synthesise key performance indicators (KPIs) relating to palliative care delivery in ICU settings. The identified KPIs will be organised into a preliminary, evidence-informed domain-based framework derived from the mapped evidence to support interpretation of the findings and inform future framework refinement and validation. We have also clarified that this represents an organising structure rather than a formally developed or validated evaluation framework. In addition, we specify that the identified KPIs will be classified using the established Donabedian Model (structure, process, and outcome) to support the organisation and interpretation of the finding \nComment 2:<\/b> \u201c\nProvide clearer operational definitions and distinctions between KPIs, quality indicators, outcome measures, and performance measures to improve conceptual consistency.\u201d<\/i> \nResponse: <\/b>We have revised the manuscript to improve conceptual clarity by providing an operational definition for the terminology used throughout the review. Specifically, we have clarified that, for the purposes of this review, the term \nKPIs<\/i> is used as the principal term to describe measurable indicators used to evaluate the delivery and integration of palliative care within ICU settings. We have also explained that related terms, including quality indicators, performance measures, and outcome measures, are incorporated into the search strategy and eligibility criteria to ensure comprehensive identification of relevant evidence, reflecting the variability in terminology used across the literature. Finally, we have clarified that the identified indicators will be classified according to the Donabedian Model (structure, process, and outcome) (Donabedian, 1988), providing a consistent conceptual framework for organising and interpreting the findings. The relevant references have been added to the manuscript to support the revised methodology. \nComment 3:<\/b> \u201c\nResolve inconsistencies in date restrictions across the protocol (10 years, 12 years, and from 2014 onward) and provide a single justified timeframe.\u201d<\/i> \nResponse:<\/b> We have revised the manuscript to ensure a consistent publication date restriction throughout the protocol. Specifically, we have standardised the eligibility criteria, search strategy, and Table 4 to include publications published from \n2014 onwards<\/b> and have removed the previous references to "10 years" and "12 years." We have also clarified the rationale for this timeframe, noting that it reflects the shift towards integrated palliative care in contemporary acute healthcare policy following the publication of the World Health Organisation and Worldwide Hospice Palliative Care Alliance guidance in 2014. These revisions improve the clarity, consistency, and reproducibility of the review methodology. \nComment 4:<\/b> \nReconsider excluding studies where "palliative care" is not explicitly stated, as relevant ICU indicators may be described using alternative terminology.<\/i> \nResponse:<\/b> See response to reviewer 1 comment 4 \nComment 5:<\/b> \u201c\nJustify the use of thematic analysis for KPI synthesis or consider a more appropriate analytic approach for indicator classification and mapping.\u201d<\/i> \nResponse:<\/b> We agree that the synthesis of KPIs differs from the analysis of qualitative data. We have therefore revised the manuscript to replace thematic analysis with an inductive descriptive content analysis, which is more appropriate for the synthesis and classification of indicators identified through a scoping review. Specifically, extracted indicators will be grouped into conceptually related categories, organised into higher-order domains, and subsequently classified according to the Donabedian Model (structure, process, and outcome). This revision provides a clearer and more methodologically appropriate approach to indicator synthesis, classification, and mapping. The relevant references have been added to the manuscript. \nComment 6:<\/b> \u201c\nConsider including a stakeholder consultation stage to strengthen the relevance and applicability of the proposed framework.\u201d<\/i> \nResponse:<\/b> We agree that stakeholder consultation can strengthen the relevance and applicability of evidence syntheses. However, in accordance with current JBI guidance, stakeholder consultation is considered an optional component of scoping review methodology rather than a mandatory stage. As the primary aim of this review is to identify and map the published evidence relating to KPIs for palliative care delivery within ICU settings, we have not included a formal stakeholder consultation stage. We have clarified that the preliminary evidence-informed framework generated through this review is intended to inform future refinement and validation, at which stage stakeholder consultation and consensus methods will be important components of framework development. \nComment 7:<\/b> \u201c\nExpand reporting of the search strategy, particularly grey literature identification and screening procedures.\u201d<\/i> \nResponse:<\/b> We have expanded the Search Strategy section to provide greater detail regarding the identification and screening of grey literature. Specifically, we have clarified that grey literature will be identified through manual searches of predefined organisational websites using each website's search function, where available, and by manually browsing relevant sections (e.g., publications, guidelines, policy documents, standards, and reports). We have also specified the search terms to be used, clarified that all retrieved records will be screened against the predefined eligibility criteria and duplicate records removed before inclusion, and stated that the grey literature search process, including the websites searched, search terms used, search dates, and the number of records retrieved, will be documented to ensure transparency and reproducibility. In addition, we have clarified that study selection will be reported using a PRISMA-ScR flow diagram. \nComment 8:<\/b> \u201c\nClarify eligibility decisions regarding policy documents, expert consensus papers, and non-peer-reviewed evidence sources.\u201d<\/i> \nResponse: <\/b>We have revised the eligibility criteria to clarify the types of grey literature eligible for inclusion in this review. Specifically, we now state that eligible non-peer-reviewed evidence includes policy documents, clinical guidelines, expert consensus statements, standards, organisational reports, and government publications that report or recommend KPIs relevant to palliative care delivery within adult ICU settings. We have also clarified that editorials, opinion pieces, commentaries, conference abstracts, and documents that do not report or describe relevant indicators will be excluded. These revisions improve the transparency and reproducibility of the eligibility criteria. \nComment 9:<\/b> \u201c\nRefine and streamline the data extraction framework to improve feasibility and analytical clarity.\u201d<\/i> \nResponse: <\/b>We have revised the data extraction framework to improve both feasibility and analytical clarity. Specifically, we have streamlined the extraction variables to focus on information directly relevant to the review objectives, including the characteristics, application, and implementation of identified KPIs. We have also removed redundant and interpretive data items and clarified the purpose of the remaining extraction variables. These revisions ensure that the extracted data directly support the planned synthesis, classification, and mapping of KPIs and the development of a preliminary evidence-informed framework for evaluating palliative care delivery within adult ICU settings. \nComment 10:<\/b> \u201c\nAddress minor language and consistency issues throughout the manuscript.\u201d<\/i> \nResponse: <\/b>We have carefully reviewed the manuscript and revised the language throughout to improve clarity, readability, and consistency. Minor grammatical, typographical, and stylistic errors have been corrected, and terminology has been standardised where appropriate to ensure consistency across the manuscript.","URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2#referee-comment-3954","order":3,"name":"referee-comment-3954","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.16009.r57341, Yodang Yodang, Universitas SembilanBelas November Kolaka, Kolaka Regency, 08 Sep 2026, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/9-44\/v2#referee-response-57341","order":4,"name":"referee-response-57341","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"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.","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}