Palliative Care Needs of Patients With Chronic Limb-Threatening Ischemia: A Scoping Review

Abstract

Context: Chronic limb-threatening ischemia is associated with a high risk of limb amputation and infection and includes lower limb ischemia, rest pain and gangrene, and impaired physical function. Palliative care for patients with chronic limb-threatening ischemia and their caregivers is important. However, reports on the need for palliative care are in consistent.

Objectives: To conduct a scoping review to identify the palliative care needs of patients with chronic limb-threatening ischemia and their caregivers.

Methods: We adopted the methodological framework for scoping reviews outlined by Arksey and O'Malley. The protocol was registered with the Open Science Framework (https://osf.io/xc2vq/). PubMed, Ovid Embase, Web of Science, EBSCO CINAHL, Cochrane Library, PsycINFO, and Google scholar were used. Eligibility criteria were studies that described palliative care needs of patients with chronic limb-threatening ischemia and their caregivers, with no limitations on the publication year.

Results: Of the 2663 articles, 14 met the eligibility criteria. The major palliative care needs were in relation to structure and process, including early intervention in palliative care and in multidisciplinary teams. Additionally, it was found that healthcare providers did not assess care needs using a comprehensive scale. Two studies used pain scales, such as the Numerical Rating Scale, and one study used a quality of life scale.

Conclusion: We recommend that hospitals improve palliative care delivery systems for patients with chronic limb-threatening ischemia and their caregivers and assess their needs using comprehensive patient-reported outcome scales. Further research using existing patient-reported outcome measures that comprehensively assess palliative care needs is needed.

Keywords: Peripheral artery disease; chronic limb threatening ischemia; critical limb ischemia; palliative care; scoping review.