Risk factors for complicated grief among family members bereaved in intensive care unit settings: A systematic review

Abstract

Background Families of intensive care unit (ICU) decedents are at increased risk of experiencing complicated grief. However, factors associated with complicated grief in ICU and bereavement needs assessment are not available routinely. We aimed to conduct a systematic review identifying risk factors associated with complicated grief among family members of ICU decedents. Materials and methods MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and Web of Science were searched to identify relevant articles. Observational studies and randomised and non-randomised controlled trials were included. Studies were screened and quality appraised in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale. A narrative synthesis was undertaken. Results Seven studies conducted across three continents were eligible. Four studies were of high quality. 61 risk factors were investigated across the studies. Factors associated with a decreased risk of complicated grief included age, patient declining treatment and involvement in decision-making. Factors associated with increased risk included living alone, partner, dying while intubated, problematic communication, and not having the opportunity to say goodbye. Conclusion This systematic review has identified risk factors which may help identify family members at increased risk of complicated grief. Many of the studies has small sample sizes increasing the risk of erroneously reporting no effect due to type II error. Some factors are specific to the ICU setting and are potentially modifiable. Bereavement services tailored to the needs of bereaved family members in ICU settings are required. (PROSPERO registration ID 209503)

ICU Family Bereavement: Demonstrating Predictors and a Call to Improve Outcomes*

“…These findings of this study align with a recent systematic review by Sanderson et al (9), which demonstrated that preparedness for death, surrogate inclusion in decision-making, and prior patient expressions to decline ICU treatments are associated with lower risks of prolonged grief. They also identified that patients on mechanical ventilation and those who required vasopressor support had family members who were more likely to experience prolonged grief.…”

“…The authors recognize that in theory their generalizability is limited to two academic medical centers in Taiwan, given specific cultural mourning practices. However, their high-risk characteristics do fall in alignment with what has been described in other literature from other countries (9). Despite differences in cultural norms, critical care practices, and even heterogeneity of study approaches, studies have demonstrated common high-risk predictors that could serve as targets for selective interventions.…”

Long-term bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study

“… 15 These factors were shown in pre-pandemic studies to be associated with the severity of grief symptoms. 19 In the present study, on an adjusted analysis, we found a significant association between persistently high or worsening grief symptoms and intubation but not physical presence or COVID-19 status. Given many family members in our cohort would not have been present at the bedside to witness intubation due to pandemic-related isolation and visiting restrictions, it is unclear from these findings whether endotracheal intubation is a marker for other factors driving changes in severe grief (e.g., patients who receive critical care and intubation may have had closer relationships with the family members who advocated for this care; these patients may also have been healthier at baseline, prompting family members to advocate for more aggressive care), or whether intubation itself, or perhaps simply the mental conception of intubation and rumination on this image, contributes to greater grief severity.…”

“…These latter factors are known to be associated with more severe grief. 19 Participants were only included in the analysis if data were available for both 6–12 months and 12–18 months.…”

The role of women in the field of early intervention

“…However, most of the analyzed publications refer to parents in a generic sense. Several studies have examined the contrasting demands and stressors, anxiety levels, and coping strategies between parents with disabled children and parents with typically developing children [ 9 , [12] , [13] , [14] , [15] ]. The majority of research participants are mothers, as shown by multiple studies focused on this topic, such as the research by Ref.…”