Complicated grief after death of a relative in the intensive care unit

Kentish-Barnes, Nancy; Chaize, Marine; Seegers, Valérie; Legriel, Stéphane; Cariou, Alain; Jaber, Samir; Lefrant, Jean‐Yves; Floccard, Bernard; Renault, Anne; Vinatier, Isabelle; Mathonnet, Armelle; Reuter, Danielle; Guisset, Olivier; Cohen-Solal, Zoé; Cracco, Christophe; Seguin, Amélie; Durand-Gasselin, Jacques; Éon, B.; Thirion, Marina; Rigaud, Jean‐Philippe; Philippon-Jouve, Bénédicte; Argaud, Laurent; Chouquer, Renaud; Adda, Mélanie; Dedrie, Céline; Georges, Hugues; Lebas, Eddy; Rolin, Nathalie; Bollaert, Pierre‐Édouard; Lécuyer, Lucien; Gérard, Viquesnel
,; Léone, Marc; Chalumeau-Lemoine, Ludivine; Garrouste, Maïté; Schlemmer, Benoı̂t; Chevret, Sylvie; Falissard, Bruno; Azoulay, Élie

doi:10.1183/09031936.00160014

Cited by 266 publications

(253 citation statements)

References 61 publications

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“…When patient/caregiverclinician collaboration is suboptimal in ICUs, negative effects can be seen on decision-making quality in the short term as well as psychological distress in the longer term; moral distress and burnout can occur among clinicians (1)(2)(3)(4). Conversely, interventions that focus on enhancing these interactions can alleviate distress, improve communication, and better align values and choice (5)(6)(7).…”

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confidence: 99%

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Huff¹,

Nadig²,

Ford³

et al. 2015

Annals ATS

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Rationale: Therapeutic alliance is a novel measure of the multifaceted caregiver-clinician relationship and a promising intervention target for improving patient-centered outcomes. However, therapeutic alliance has not been studied in an intensive care unit (ICU) setting.Objectives: To explore the relationships among caregiver-reported therapeutic alliance and psychological distress as well as patient, caregiver, and ICU clinician factors. Methods:In this cross-sectional study, we enrolled consecutive patient caregivers of mechanically ventilated patients discharged from all ICUs at Duke University and the Medical University of South Carolina Hospitals between December 2013 and August 2014. Measurements and Main Results:Caregivers completed an in-person, hospital-based interview that included measures of therapeutic alliance with the ICU physicians (Human Connection Scale) as well as patient centeredness of care; symptoms of depression, anxiety, and post-traumatic stress; decisional conflict; and quality of communication. We performed a multivariate regression to characterize associations between Human Connection Scale scores and key variables. A total of 56 caregivers were included in these exploratory analyses. Patients were largely disabled (47%) and Medicare insured (53%). Caregivers were highly educated and generally had high therapeutic alliance (median, 55; interquartile range, 48-58) with the ICU clinicians. Therapeutic alliance was strongly correlated with patient centeredness (r = 0.78) and poorly correlated with psychological distress (r , 0.2). Stepwise multivariate modeling revealed that higher therapeutic alliance was associated with fewer baseline patient comorbidities as well as caregiver report of greater trust in the ICU team, better quality of communication, and less decisional conflict (all P , 0.012).Conclusions: Therapeutic alliance encompasses measures of trust, communication, and cooperation, which are intuitive to forming a good working relationship. Therapeutic alliance among ICU caregivers is strongly associated with both modifiable and nonmodifiable factors. Our exploratory study highlights new intervention targets that may inform strategies for improving the quality of the caregiver-clinician interaction.

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mentioning

confidence: 99%

Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians

Huff¹,

Nadig²,

Ford³

et al. 2015

Annals ATS

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“…Although delaying discontinuation of organ support can give a family time to come to terms with a patient's death, 6,7,16 it can also promote confusion about the patient's status and increase the risk of complicated grief (a state of profound grief for greater than 6 months that is marked by disbelief, anger, bitterness, intrusive thoughts of the deceased, and difficulty moving on in life). 3,5,6,8,17 For clinicians and hospital personnel, ongoing treatment after DNC can be seen as a violation of a patient's dignity and bodily integrity, and a misallocation of valuable resources including an intensive care unit bed, medical equipment, medications, and health care professionals' time and energy. 3,5,6,8,9,16 These situations are emotionally taxing for both clinicians and families.…”

Section: Solo Practice 21 20mentioning

confidence: 99%

Organ support after death by neurologic criteria

et al. 2016

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Objective: We sought to evaluate how neurologists approach situations in which families request prolonged organ support after declaration of death by neurologic criteria (DNC). Methods:We surveyed 938 members of the American Academy of Neurology (AAN) who treat critically ill patients, including 50% who practice in states with accommodation exceptions (states that require religious or moral beliefs to be taken into consideration when declaring death or discontinuing organ support: California, Illinois, New Jersey, New York), and 50% who practice in nonaccommodation states.Results: The survey was completed by 201/938 individuals (21% response rate), 96 of whom were from accommodation states and 105 of whom were from nonaccommodation states. Both groups reported encountering situations in which families requested continuation of organ support after DNC (48% from accommodation states and 46% from nonaccommodation states). In a hypothetical scenario where a request is made to continue organ support after DNC (outside of organ donation), 48% of respondents indicated they would continue support due to fear of litigation. In reply to an open-ended question, respondents requested that the AAN generate guidelines and advocate to codify laws regarding organ support after DNC, and to improve public and physician education on DNC.Conclusions: Our findings suggest that it is relatively common for neurologists who treat critically ill patients to encounter families who object to discontinuation of organ support after DNC at some point during their career. It would be beneficial for physicians, families, and society to rely on clear medicolegal guidelines on management of this situation. Death by neurologic criteria (DNC) is legally accepted throughout the United States as equivalent to cardiopulmonary death.1 The American Academy of Neurology (AAN) advises that organ support be discontinued after declaration of DNC unless donation is planned, 2 but families sometimes request continuation of support. [3][4][5][6][7][8][9] Four states have legal accommodation exceptions.10-13 New Jersey's statute states that DNC cannot be declared in violation of a patient's religious beliefs.11 In California and New York, hospitals are instructed to make reasonable efforts to accommodate religious or moral objections to DNC. 10,12 In Illinois, hospitals are told to take religious beliefs into account when determining time of death. 13The questions of what constitutes reasonable accommodation and how these situations should be handled in states that do not have accommodation exceptions have left physicians, nurses, administrators, and ethics committees flustered. 3,[7][8][9] Although there are case reports 3-9 on management of objection to DNC, there are no universal legal or medical society guidelines to dictate behavior in these challenging cases. As a result, the frequency of objection to DNC and the manner in which individual centers handle From the

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“…The availability of other healthcare professionals, such as psychologists (51), social workers (52) (53) in a multidisciplinary team setting can also contribute to increasing family satisfaction with encounters with the ICU caregivers, and is recommended, albeit with a low level of evidence, in recent guidelines for family-centred care in the ICU (8). Similarly, families can be offered the possibility to see a chaplain or other religious representative to accompany them in accordance with their religious beliefs, particularly in situations where the prognosis is poor.…”

Section: The Specific Situation Of End-of-life Decisionsmentioning

confidence: 99%