A Randomized Trial of a Family-Support Intervention in Intensive Care Units

White, Douglas B.; Angus, Derek C.; Shields, Anne-Marie; Buddadhumaruk, Praewpannarai; Pidro, Caroline J; Paner, Cynthia; Chaitin, Elizabeth; Chang, Chung‐Chou H.; Pike, Francis; Weissfeld, Lisa A.; Kahn, Jeremy M.; Darby, Joseph M.; Kowinsky, Amy; Martin, S.R.; Arnold, Robert M.

doi:10.1056/nejmoa1802637

Cited by 380 publications

(368 citation statements)

References 48 publications

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“…However, evidence-informed bereavement care practices, including a family-support intervention that utilises meaningful, well-structured and timed communication between clinicians and the patient's family before death [53] and nurses' evaluation of the use of music during after death care [54] draw attention to support for grieving families' prior to and in the immediate after-math of patient death in the ICU. Walker and Trapani suggest a classification of care for grieving families in the contexts of 'EoL care prior to patient death' and 'bereavement care following patient death' in the ICU [21].…”

Section: Discussionmentioning

confidence: 99%

The state of bereavement support in adult intensive care: A systematic review and narrative synthesis

Efstathiou

Walker

Metcalfe

et al. 2019

Journal of Critical Care

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Purpose: Despite advances in medical science, patient death and family bereavement are commonly encountered in adult intensive care units (ICUs). This is the first review to investigate the state of ICU bereavement support globally, and the availability and effectiveness of bereavement support interventions.Methods: A systematic review and narrative synthesis. Medline, CINAHL Plus, PsycINFO, Web of Science, EMBASE were searched and inclusion/exclusion criteria were applied. Included studies were appraised using relevant appraisal tools.Results: Fourteen papers formed the review; five of which were international surveys reporting variable bereavement practices and levels of support. A lack of training and resources were identified barriers. Nine papers reported the effectiveness of primarily discrete bereavement support interventions including: a personal memento, a handwritten condolence letter, a post-death meeting; storytelling, research participation, use of an ICU diary. One study evaluated a bereavement follow-up program. Generally, all identified interventions were well accepted by bereaved families.Conclusions: The reviewed evidence was weak, and findings were contextually bound. As such, it is difficult to make recommendations for the most acceptable and effective bereavement support intervention(s). Bereavement support in ICU needs further exploration and clinicians must be adequately trained and supported for the delivery of evidence-informed, culturally competent care.

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Section: Discussionmentioning

confidence: 99%

The state of bereavement support in adult intensive care: A systematic review and narrative synthesis

Efstathiou

Walker

Metcalfe

et al. 2019

Journal of Critical Care

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“…Accompanying this emerging trend, significant evidence has addressed post‐intensive care syndrome and post‐intensive care syndrome‐family . Research efforts in prevention and interventions to mitigate the negative consequences experienced by patients and family members after a critical illness experience have included exploration of the utility of follow‐up programmes, specific family support interventions delivered within the ICU, and theoretical development related to this emerging area …”

Section: Background: Justification For Reviewmentioning

confidence: 99%

Inter‐facility transfers for advanced critical care services: Impacts on rural families

Burns

Petrucka

2019

Nursing in Critical Care

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Aims and Objectives: The aim of this article is to provide an integrative review of rural family members' experiences of a relative's inter-facility transfer to an urban tertiary care centre for advanced critical care services.Background: Although there is an increasing awareness of the negative consequences of a relative's critical illness for family members, there has been limited research conducted on the impacts of this experience for families of patients in rural settings who require an inter-facility transfer for advanced services.Search strategy: The search strategy for this review was framed by the study purpose, research question, and a conceptual structure of key constructs. Databases and reference lists were electronically and manually searched.Inclusion and exclusion criteria: Articles were included if they were research articles, available in English, and focused on family members' experiences of inter-facility transfer during critical illness. Articles focusing on critical care transfers within a single urban setting, elective transfers undertaken for patient or family preference, transfers not associated with critical illness, and systematic or scoping reviews were excluded.Conclusion: Stress and anxiety are central to the rural family members' experience of this phenomenon. These constructs are influenced by modifiable factors, including the actions of health care providers, the financial burden associated with the transfer, the family members' physical proximity to the patient, and their access to information and support networks. Further research is required to explore potential short-and long-term consequences of this experience and the experience of family members who are left behind and to develop and test interventions to support families.Relevance to clinical practice: This review highlights the concern that health care providers frequently misunderstand the needs of family members who are experiencing this phenomenon. Through a better understanding of this phenomenon, health care providers will be better positioned to effectively support these individuals during this unique experience. K E Y W O R D Scritical illness, family, integrative review, interfacility transfer, rural

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“…To that effect, we focused on RPs, with whom all remote communications took place: the novel context of the pandemic gave this status a speci c signi cance in need of examination. While most work on the responsibility and distress associated with being a reference person focuses on decision making [15], being an RP in the context of the COVID-19 pandemic chie y meant having to be the sole, designated intermediate between ICU caregivers and the rest of the family and/or close ones. To our knowledge, this hasn't been explored in published literature.…”

Section: Introductionmentioning

confidence: 99%

Psychological Effects of Remote-only Communication Among Reference Persons of ICU Patients During COVID-19 Pandemic

Cattelan

Castellano²,

Merdji

et al. 2020

Preprint

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Background: During COVID-19 pandemic, visitations have been prohibited in most French ICUs. We aimed to assess psychological effects, for reference persons (RPs), of experiencing remote-only communication with both caregivers and the patient during COVID-19 pandemic.Methods: All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death and 3 months. At 3 months, an interview with a psychologist provided a qualitative description of RPs’ psychological distress.Results: Eighty-eight RPs were interviewed at patient admission and discharge, and 33 accepted the 3rd month-interview. Prevalence of anxiety and depression symptoms was 65% and 32% respectively at patient admission and 27% and 24% at discharge/death, with a significant decrease between ICU admission and discharge/death (23 [16;31] versus 16 [9;21] points, p<0.01). At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p<0.01). Despite visit prohibition, 99% RPs felt the patient was safe (9 [7;10]/10 points, Likert-type scale). They also felt confident with caregivers, therapeutic decisions (10 [9;10]/10 points) and satisfied with the manner/frequency information was provided (10 [9;10]/10 points). All RPs stressed the specific-type of “responsibility” associated with being an RP in a remote-only context. The 3 salient themes turned out to be dichotomous variables: positive (9 RPs, 27%) vs. negative (24 RPs, 73%) subjective experience; wide (11 RPs, 33%) vs. narrow (22 RPs, 67%) information diffusion strategies: only a third chose to transmit the information to many relatives. Only 10 RPs (30%) related the situation to a prior traumatic experience.Conclusion: In a distressing situation, remote-only communication allowed RPs to remain involved in decision processes and maintain contact with patient and caregivers.Trial registration: NCT04385121. Registered 12 May 2020. https://clinicaltrials.gov/

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A Randomized Trial of a Family-Support Intervention in Intensive Care Units

Cited by 380 publications

References 48 publications

The state of bereavement support in adult intensive care: A systematic review and narrative synthesis

The state of bereavement support in adult intensive care: A systematic review and narrative synthesis

Inter‐facility transfers for advanced critical care services: Impacts on rural families

Psychological Effects of Remote-only Communication Among Reference Persons of ICU Patients During COVID-19 Pandemic

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