Table 2 Summary of the included quantitative studies

Mani (2017)

Country: Saudi Arabia

Objective: To explore nurses’ perceptions of obstacles to the provision of end-of-life care in the intensive care unit (ICU) in Saudi Arabia.

Conducted in a 936 bed specialist hospital in Riyadh between March and April 2015 There were 129 adult ICU beds in 6 specialist ICUs, including medical, hematological, oncological, surgical, and cardiac.

All nurses working in ICU were eligible for the study.

Quantitative cross-sectional design

Convenience sample of 77 ICU nurses

NSCCNR-EOLC Questionnaire

Measures reported intensity and frequency of 29 obstacle items on a Likert scale ranging from 0–5.

Intensity: 0 = least intense; 5 = most intense.

Frequency: 0 = never occurs; 5 = always occurs.

Open-ended questions: additional information on obstacles; aspects of care they would change; other comments.

Response rate was 62% (87/140). 10 incomplete responses were excluded.

The mean score for each intensity items was calculated. Scores ranged from 1.27 to 4.26. The four highest obstacle intensity items were related to family issues, including Families not accepting what the physician is telling them about the patient’s poor prognosis. (4.26), The nurse having to deal with angry family members. (4.13) and family and friends who continually call the nurse wanting an update on the patient’s condition rather than calling the designated family member for information (4.06). These obstacles were also ranked in the top six for frequency

The major barriers were related to communication with and caring for patients’ families. Patient’s family, physicians with different opinions, cultural differences and language barriers were also highlighted.

Nurses also reported the need for educational awareness and involvement of family in end-of-life care and futile care.

Almansour (2019)

Country: Jordan

Objective: To determine perceptions of Jordanian critical care staff about intensity and frequency of obstacles and facilitators to end-of-life care.

Conducted in two teaching hospitals and in five critical care units. The hospitals have western style health care.

Critical care staff were eligible if they were involved in providing care for dying patients and employed in the units at the time of the study.

Quantitative Cross -sectional design

Convenience sample of 104 ICU staff (76 nurses + 28 physicians) for Obstacles survey

76 ICU nurses for facilitators survey

NSCCNR-EoLC Questionnaire

The first section uses a 5-point Likert scale to measure perceptions of intensity of 29 obstacles to EOL care ranging from 0 (not an obstacle) to 5 (an extremely large obstacle) and the frequency of their occurrence, ranging from 0 (never occurs) to 5 (always occurs).

The second section uses a 5-point Likert scale to access perceptions about the intensity of 24 facilitators to EOL care, ranging from 0 (not a help) to 5 (extremely large) and the frequency of occurrence, ranging from 0 (never occurs) to 5 (always occurs).

The overall response rate was 72.7% (n = 104/143). 76 nurses (69.1%) and 28 physicians (84.5%) responded.

Nurses and physicians perceived that the most intense obstacle to EOL care was: “family members not understanding what life-saving measures really mean” (Nurses: M = 4.12; Physicians: M = 3.92), then “clinicians who are evasive and avoid having conversations with family members” (Nurses: M = 3.71; Physicians: M = 3.46).

The most intense facilitator to EOL care perceived by nurses was “having family members accept that the patient is dying” (M = 4.12).

Nurses and physicians agreed that the highest scoring obstacles were related to family members and the poor design of critical care units. Other highly scoring obstacles related to clinicians’ behaviours, characteristics and attitudes.

Nurses perceived the highest scoring facilitator was related to family members and then the physicians practice/agreement about the care.

Attia (2013)

Egypt

Questions: Which barriers to providing EOL care to critically ill patients do critical care nurses perceive as the most intense? Which supportive behaviors to providing EOL care to critically ill patients do critical care nurses perceive of great help?

The study was conducted in four ICUs at Mansoura University Hospitals, Egypt, namely the oncology ICU, the coronary care unit, the hepatic ICU, and the surgical ICU.

Quantitative

Cross-sectional design

Convenience sample of 70 ICU nurses

The instrument adapted from NSCCNR-EOLC and translated into Arabic.

25 barrier items and 19 possible help behaviors. A 4-point Likert-type scale ranging from 1 = not a barriers/help to 4 = a great barrier/help.

Response rate 100%.

The response to each items in the survey was calculated in percentage.

The top items reported as severe barriers were associated with issues related to the ICU environment such as nurses’ heavy workload (81.4%), the poor ICU design (67.1%), and the liberal unit visiting hours (51.4%). Some items were related to patients’ family such as family members who do not understand the meaning of life-saving measures (65.7%) and family who continually call the nurse for updated information on the patient’s condition (62.9%).

The highest supportive behaviors were nurses’ support involved good communication between

physicians and nurses caring for the dying patient

(94.3%), nurses drawing on their own previous experiences

(82.9%), and supporting each other after the death of their

patients (75.7%)

Barriers to providing EOL care were mainly related to intensive care environment, family members, followed by nurses’ knowledge and skills, physicians’ attitudes and treatment policy.

However, the highest possible help to providing EOL care were nurses’ support and family-centered care, and families’ support.