Supporting families of patients who die in adult intensive care: A scoping review of interventions |
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| Affiliation: | 1. Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia;2. The Centre for Palliative Care, St Vincent’s Hospital Melbourne, 172 Victoria Parade, East Melbourne, Victoria 3002, Australia;3. Nursing Research Institute, St Vincent''s Health Network Sydney, St Vincent''s Hospital Melbourne & Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia;4. Library and Academic Research Services, Australian Catholic University, Melbourne, Australia;5. Vrije University, Brussels, Belgium;1. Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan;2. Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;3. School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan;4. Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;5. Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;1. Federal University of Acre, Rio Branco, Acre, Brazil;2. Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil;3. Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway;1. Hebrew University Faculty of Medicine School of Nursing, PO Box 12000, Jerusalem 91120, Israel;2. Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel;3. Jerusalem College of Technology, Israel;1. School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia;2. Sunshine Coast Health Institute, Sunshine Coast, Queensland, Australia;3. Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia;4. Intensive Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia;5. Intensive Care Unit, Hervey Bay Hospital, Hervey Bay, Queensland, Australia;6. School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia;7. Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia;8. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, UK;9. Department of Marketing, Griffith University, Gold Coast, Queensland, Australia;10. Consumer Advisory Group, Gold Coast Health, Queensland, Australia;11. Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia |
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| Abstract: | BackgroundFamilies who perceive themselves as prepared for an impending death experience reduced psychological burden during bereavement. Understanding which interventions promote death preparedness in families during end-of-life care in intensive care will inform future intervention development and may help limit the burden of psychological symptoms associated with bereavement.AimTo identify and characterise interventions that help prepare families for the possibility of death in intensive care, incorporating barriers to intervention implementation, outcome variables and instruments used.DesignScoping review using Joanna Briggs methodology, prospectively registered and reported using relevant guidelines.Data sourcesA systematic search of six databases from 2007 to 2023 for randomised controlled trials evaluating interventions that prepared families of intensive care patients for the possibility of death. Citations were screened against the inclusion criteria and extracted by two reviewers independently.ResultsSeven trials met eligibility criteria. Interventions were classified: decision support, psychoeducation, information provision. Psychoeducation involving physician-led family conference, emotional support and written information reduced symptoms of anxiety, depression, prolonged grief, and post-traumatic stress in families during bereavement. Anxiety, depression, and post-traumatic stress were assessed most frequently. Barriers and facilitators to intervention implementation were seldom reported.ConclusionThis review provides a conceptual framework of interventions to prepare families for death in intensive care, while highlighting a gap in rigorously conducted empirical research in this area. Future research should focus on theoretically informed, family-clinician communication, and explore the benefits of integrating existing multidisciplinary palliative care guidelines to deliver family conference within intensive care.Implications for clinical practiceIntensive care clinicians should consider innovative communication strategies to build family-clinician connectedness in remote pandemic conditions. To prepare families for an impending death, mnemonic guided physician-led family conference and printed information could be implemented to prepare families for death, dying and bereavement. Mnemonic guided emotional support during dying and family conference after death may also assist families seeking closure. |
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| Keywords: | Scoping review Intensive care units Critical care Family Bereavement Psychological distress Palliative care Terminal care End of life care |
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