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van Mol MMC, Wagener S, Latour JM, Boelen PA, Spronk PE, den Uil CA, Rietjens JAC. Developing and testing a nurse-led intervention to support bereavement in relatives in the intensive care (BRIC study): a protocol of a pre-post intervention study. BMC Palliat Care 2020; 19:130. [PMID: 32811499 PMCID: PMC7433274 DOI: 10.1186/s12904-020-00636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND When a patient is approaching death in the intensive care unit (ICU), patients' relatives must make a rapid transition from focusing on their beloved one's recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is to develop and implement a multicomponent bereavement support intervention for relatives of deceased ICU patients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression and posttraumatic stress in bereaved relatives. METHODS The study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in the Netherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in 2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities and evidence-based practices, a nurse-led intervention will be developed and implemented during the study period. This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, will serve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200 relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety, depression and posttraumatic stress. Differences between the baseline and follow-up measurements will be calculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, risk profiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted. DISCUSSION The newly developed intervention has the potential to improve the bereavement process of the relatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression, anxiety and posttraumatic stress, might decrease. TRIAL REGISTRATION Netherlands Trial Register Registered on 27/07/2019 as NL 7875, www.trialregister.nl.
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Affiliation(s)
- Margo M. C. van Mol
- Department of Intensive Care Adults, Erasmus MC University Medical Center, P.O. Box 2040, Room Ne409, 3000 CA Rotterdam, the Netherlands
| | - Sebastian Wagener
- Department of Intensive Care Adults, Erasmus MC University Medical Center, P.O. Box 2040, Room Ne409, 3000 CA Rotterdam, the Netherlands
| | - Jos M. Latour
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Paul A. Boelen
- Clinical Psychology Faculty Social Sciences, Arq Psychotrauma Expert Groep, University Utrecht, Utrecht, Netherlands
| | - Peter E. Spronk
- Department of Intensive Care Medicine, ExpIRA - Expertise Center for Intensive Care Rehabilitation Apeldoorn, Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands
| | - Corstiaan A. den Uil
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Selman LE, Chao D, Sowden R, Marshall S, Chamberlain C, Koffman J. Bereavement Support on the Frontline of COVID-19: Recommendations for Hospital Clinicians. J Pain Symptom Manage 2020; 60:e81-e86. [PMID: 32376262 PMCID: PMC7196538 DOI: 10.1016/j.jpainsymman.2020.04.024] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023]
Abstract
Deaths due to COVID-19 are associated with risk factors which can lead to prolonged grief disorder, post-traumatic stress, and other poor bereavement outcomes among relatives, as well as moral injury and distress in frontline staff. Here we review relevant research evidence and provide evidence-based recommendations and resources for hospital clinicians to mitigate poor bereavement outcomes and support staff. For relatives, bereavement risk factors include dying in an intensive care unit, severe breathlessness, patient isolation or restricted access, significant patient and family emotional distress, and disruption to relatives' social support networks. Recommendations include advance care planning; proactive, sensitive, and regular communication with family members alongside accurate information provision; enabling family members to say goodbye in person where possible; supporting virtual communication; providing excellent symptom management and emotional and spiritual support; and providing and/or sign-posting to bereavement services. To mitigate effects of this emotionally challenging work on staff, we recommend an organizational and systemic approach which includes access to informal and professional support.
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Affiliation(s)
- Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Davina Chao
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ryann Sowden
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steve Marshall
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK; King's College Hospital NHS Foundation Trust, Palliative Care Service, London, UK
| | - Charlotte Chamberlain
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Downar J, Sinuff T, Kalocsai C, Przybylak-Brouillard A, Smith O, Cook D, Koo E, Vanderspank-Wright B, des Ordons AR. A qualitative study of bereaved family members with complicated grief following a death in the intensive care unit. Can J Anaesth 2020; 67:685-693. [PMID: 32052371 DOI: 10.1007/s12630-020-01573-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Grief is a normal reaction, and most family members (FMs) experience grief following a death. Typically, grief subsides without any major psychological or medical impairment. Nevertheless, some FMs may experience complicated grief (CG) reactions, with symptoms lasting months or years, and CG is particularly prominent among FMs of those who die in the intensive care unit (ICU). The purpose of this study was to examine how FMs experience grief, particularly CG, to inform future early screening and support programs in the ICU. METHODS This was a multicentre qualitative study focusing on semi-structured interviews with FMs who displayed symptoms of CG. Family members of patients who died in the ICU and who had a six-month inventory of CG score > 25 were included. Semi-structured interviews were conducted with FMs post-loss, with follow-up interviews three months after the initial interviews. RESULTS Major themes identified following thematic analysis from eight participants with CG included 1) ante-mortem experience: the impact of the ICU experience prior to death of a loved on subsequent grief; 2) post-mortem experience: unpredictable post death reactions; 3) coping strategies: techniques used to reduce the severity of grief reactions; 4) sources of support: focusing on resources that the FM draws from for emotional support; and 5) perspectives on future ICU bereavement screening and support programs: advice that FM participants provided for future bereavement support. CONCLUSION Bereaved FMs with CG described their experiences with grief, how ICU events influenced their bereavement, their coping strategies and sources of support, and their advice for future bereavement support programs for FMs of deceased ICU patients.
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Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Critical Care, The Ottawa Hospital, 43 Bruyere St. Ste 267J, Ottawa, ON, K1N 5C8, Canada.
- University Health Network, Toronto, ON, Canada.
| | - Tasnim Sinuff
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Orla Smith
- St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Cook
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ellen Koo
- University Health Network, Toronto, ON, Canada
| | - Brandi Vanderspank-Wright
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, AB, Canada
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Erikson A, McAdam J. Bereavement Care in the Adult Intensive Care Unit. Crit Care Nurs Clin North Am 2020; 32:281-294. [DOI: 10.1016/j.cnc.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Chen C, Michaels J, Meeker MA. Family Outcomes and Perceptions of End-of-Life Care in the Intensive Care Unit: A Mixed-Methods Review. J Palliat Care 2019; 35:143-153. [PMID: 31543062 DOI: 10.1177/0825859719874767] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this review was to evaluate end-of-life care (EOLC) in the intensive care unit (ICU) from the perspective of family members. Sandelowski's segregated approach from Joanna Briggs Institute (JBI) Mixed-Methods Systematic Reviews guided this review. A search was conducted in PubMed, CINAHL, PsycINFO, EMBASE, and ProQuest databases and identified 50 papers (33 quantitative, 15 qualitative, and 2 mixed-methodology studies). Five synthesized themes (distressing emotions, shared decision-making, proactive communication, personalized end-of- life care, and valuing of nursing care) were identified. For quantitative results, study methodologies and interventions were heterogeneous and did not always improve family members' perceived quality of care and family members' psychological distress. Configuration of qualitative and quantitative data revealed ICU end-of-life interventions were ineffective because they were not guided by family members' reported needs and perceptions. To fulfill the family members' needs for the patients' EOLC in the ICU, researchers should develop a theory to explicitly explain how the family members experience ICU EOLC and implement a theory-based intervention to improve family psychological outcomes.
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Affiliation(s)
- Chiahui Chen
- School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA
| | - Jacqueline Michaels
- School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA.,School of Nursing and Allied Health, SUNY Empire State College, Saratoga Springs, NY, USA
| | - Mary Ann Meeker
- School of Nursing, University at Buffalo-The State University of New York, Buffalo, NY, USA
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Laurent A, Reignier J, Le Gouge A, Cottereau A, Adda M, Annane D, Audibert J, Barbier F, Bardou P, Bourcier S, Bourenne J, Boyer A, Brenas F, Das V, Desachy A, Devaquet J, Feissel M, Ganster F, Garrouste-Orgeas M, Grillet G, Guisset O, Hamidfar-Roy R, Hyacinthe AC, Jochmans S, Jourdain M, Lautrette A, Lerolle N, Lesieur O, Lion F, Mateu P, Megarbane B, Merceron S, Mercier E, Messika J, Morin-Longuet P, Philippon-Jouve B, Quenot JP, Renault A, Repesse X, Rigaud JP, Robin S, Roquilly A, Seguin A, Thevenin D, Tirot P, Vinatier I, Azoulay E, Robert R, Kentish-Barnes N. “You helped me keep my head above water”—experience of bereavement research after loss of a loved one in the ICU: insights from the ARREVE study. Intensive Care Med 2019; 45:1252-1261. [DOI: 10.1007/s00134-019-05722-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022]
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Trapani J, Walker W. What's in this Special Issue. Nurs Crit Care 2019; 24:185-188. [PMID: 31359534 DOI: 10.1111/nicc.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Wendy Walker
- Institute of Health, University of Wolverhampton, UK
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Kentish‐Barnes N. Bereavement care and research in the intensive care unit: Opportunities and challenges. Nurs Crit Care 2019; 24:189-191. [DOI: 10.1111/nicc.12457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nancy Kentish‐Barnes
- Assistance Publique‐Hôpitaux de Paris, Famiréa Research GroupMedical Intensive Care Saint‐Louis University Hospital Paris France
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61
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Garrouste-Orgeas M, Flahault C, Vinatier I, Rigaud JP, Thieulot-Rolin N, Mercier E, Rouget A, Grand H, Lesieur O, Tamion F, Hamidfar R, Renault A, Parmentier-Decrucq E, Monseau Y, Argaud L, Bretonnière C, Lautrette A, Badié J, Boulet E, Floccard B, Forceville X, Kipnis E, Soufir L, Valade S, Bige N, Gaffinel A, Hamzaoui O, Simon G, Thirion M, Bouadma L, Large A, Mira JP, Amdjar-Badidi N, Jourdain M, Jost PH, Maxime V, Santoli F, Ruckly S, Vioulac C, Leborgne MA, Bellalou L, Fasse L, Misset B, Bailly S, Timsit JF. Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA 2019; 322:229-239. [PMID: 31310299 PMCID: PMC6635906 DOI: 10.1001/jama.2019.9058] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. OBJECTIVES To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. DESIGN, SETTING, AND PARTICIPANTS Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. INTERVENTIONS Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. MAIN OUTCOMES AND MEASURES The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. RESULTS Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. CONCLUSIONS AND RELEVANCE Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02519725.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical unit, French British Hospital, Levallois-Perret, France
| | - Cécile Flahault
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Isabelle Vinatier
- Medical ICU, Les Oudaries Hospital, La Roche-sur-Yon, Vendée, France
| | | | | | - Emmanuelle Mercier
- CRICS-TRIGGERSEP group, Medical-Surgical ICU, Tours University Hospital, Tours, France
| | - Antoine Rouget
- Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France
| | - Hubert Grand
- Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France
| | | | - Fabienne Tamion
- Medical ICU, University Medical Center, Rouen, France
- INSERM U-1096, University of Rouen, Rouen, France
| | - Rebecca Hamidfar
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Anne Renault
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | | | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Cédric Bretonnière
- Medical ICU, Nantes University Hospital, Nantes, France
- EA3826, Laboratory of Clinical and Experimental Therapeutics of Infections, University of Nantes, Nantes, France
| | - Alexandre Lautrette
- Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France
- LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, France
| | - Julio Badié
- Medical-Surgical ICU, General Hospital Belfort-Montbéliard, Belfort, France
| | - Eric Boulet
- Medical ICU, Beaumont General Hospital, Beaumont, France
| | - Bernard Floccard
- Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Xavier Forceville
- Medical-Surgical ICU, Great Hospital of East Francilien, Meaux, France
| | - Eric Kipnis
- Surgical ICU, Lille University Hospital, Lille, France
| | - Lilia Soufir
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Naike Bige
- Medical ICU, Saint Antoine University Hospital, Paris, France
| | - Alain Gaffinel
- Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olfa Hamzaoui
- Medical Surgical ICU, University Hospital Paris -Sud, Beclère University Hospital, Clamart, France
| | - Georges Simon
- Medical-Surgical ICU, General Hospital, Troyes, France
| | - Marina Thirion
- Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France
| | - Lila Bouadma
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
| | - Audrey Large
- Medical ICU, François Mitterrand University Hospital, Dijon, France
| | - Jean-Paul Mira
- Medical ICU, Cochin University Hospital, Paris Centre Hospital Group, AP-HP, Paris, France
| | | | - Mercé Jourdain
- Group of medical ICUs, Lille University Hospital, Lille, France
- Lille University, Inserm U1190, Lille, France
| | - Paul-Henri Jost
- Surgical ICU, Henri Mondor University Hospital, Créteil, France
| | - Virginie Maxime
- Medical ICU, Raymond Poincaré University Hospital, Garches, France
| | - François Santoli
- Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France
| | | | - Christel Vioulac
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Marie Annick Leborgne
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Lucie Bellalou
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Léonor Fasse
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Benoit Misset
- Medical ICU, University Medical Center, Rouen, France
| | - Sébastien Bailly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Grenoble Alpes University, INSERM, University hospital Grenoble Alpes, HP2, Grenoble, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
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Prigerson HG, Viola M, Brewin CR, Cox C, Ouyang D, Rogers M, Pan CX, Rabin S, Xu J, Vaughan S, Gordon-Elliot JS, Berlin D, Lief L, Lichtenthal WG. Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience (EMPOWER) among Surrogate Decision-Makers of ICU Patients: study protocol for a randomized controlled trial. Trials 2019; 20:408. [PMID: 31288829 PMCID: PMC6617585 DOI: 10.1186/s13063-019-3515-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Critical illness increases the risk for poor mental health outcomes among both patients and their informal caregivers, especially their surrogate decision-makers. Surrogates who must make life-and-death medical decisions on behalf of incapacitated patients may experience additional distress. EMPOWER (Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience) is a novel cognitive-behavioral, acceptance-based intervention delivered in the intensive care unit (ICU) setting to surrogate decision-makers designed to improve both patients' quality of life and death and dying as well as surrogates' mental health. METHODS Clinician stakeholder and surrogate participant feedback (n = 15), as well as results from an open trial (n = 10), will be used to refine the intervention, which will then be evaluated through a multisite randomized controlled trial (RCT) (n = 60) to examine clinical superiority to usual care. Feasibility, tolerability, and acceptability of the intervention will be evaluated through self-report assessments. Hierarchical linear modeling will be used to adjust for clustering within interventionists to determine the effect of EMPOWER on surrogate differences in the primary outcome, peritraumatic stress. Secondary outcomes will include symptoms of post-traumatic stress disorder, prolonged grief disorder, and experiential avoidance. Exploratory outcomes will include symptoms of anxiety, depression, and decision regret, all measured at 1 and 3 months from post-intervention assessment. Linear regression models will examine the effects of assignment to EMPOWER versus the enhanced usual care group on patient quality of life or quality of death and intensity of care the patient received during the indexed ICU stay assessed at the time of the post-intervention assessment. Participant exit interviews will be conducted at the 3-month assessment time point and will be analyzed using qualitative thematic data analysis methods. DISCUSSION The EMPOWER study is unique in its application of evidence-based psychotherapy targeting peritraumatic stress to improve patient and caregiver outcomes in the setting of critical illness. The experimental intervention will be strengthened through the input of a variety of ICU stakeholders, including behavioral health clinicians, physicians, bereaved informal caregivers, and open trial participants. Results of the RCT will be submitted for publication in a peer-reviewed journal and serve as preliminary data for a larger, multisite RCT grant application. TRIAL REGISTRATION ClinicalTrials.gov, NCT03276559 . Retrospectively registered on 8 September 2017.
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Affiliation(s)
- Holly G. Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY USA
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Martin Viola
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY USA
| | - Chris R. Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Christopher Cox
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Duke University, Durham, NC USA
| | - Daniel Ouyang
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY USA
| | | | - Shayna Rabin
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY USA
| | - Jiehui Xu
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY USA
| | - Susan Vaughan
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY USA
| | | | - David Berlin
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Lindsay Lief
- Department of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Wendy G. Lichtenthal
- Department of Psychiatry, Weill Cornell Medicine, New York, NY USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
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Egerod I, Kaldan G, Albarran J, Coombs M, Mitchell M, Latour JM. Elements of intensive care bereavement follow-up services: A European survey. Nurs Crit Care 2019; 24:201-208. [PMID: 31237406 DOI: 10.1111/nicc.12459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite technological innovations and continuous improvement in evidence-based treatments, mortality in the intensive care unit (ICU) remains high. Consequently, a large group of family members may be in need of, and could benefit from, bereavement follow-up support. AIMS AND OBJECTIVES To explore the elements, organization, and evaluation of ICU bereavement services in European countries. Specific objectives were to investigate: (a) the model of bereavement follow-up services (elements of support), (b) the workforce model (organization of staff), and (c) the evaluation model (evaluation strategies). DESIGN This was a cross-sectional survey of conference delegates. METHODS A paper-and-pen questionnaire, including a cover letter assuring the respondents of anonymity and confidentiality, was distributed to 250 delegates during the opening ceremony of the 2017 European federation of Critical Care Nurses associations Congress in Belfast. The questionnaire was developed from a previously validated tool describing bereavement care practices in ICUs, including questions about the content and organization of bereavement follow-up services. Frequencies were calculated using yes/no questions, and content analysis was applied in additional free-text comments. RESULTS We received 85 responses from publicly employed nurses, mainly in mixed adult ICUs. Respondents were 48 (56.5%) bedside nurses, and the remaining respondents represented clinical nurse specialists, researchers, managers, or academic nurses. Bereavement follow up had existed for about 1 to 15 years. Important follow-up elements were: viewing the deceased in the unit, 77 (90.6%); providing follow-up information, 67 (79.8%); sending a letter of sympathy, 17 (20%); and calling the family to arrange a meeting, 27 (31%). CONCLUSIONS Bereavement follow up is common but variable in European ICUs. We recommend the development, implementation, and evaluation of evidence-based, but culture-specific, bereavement follow-up guidelines for European ICUs. RELEVANCE TO CLINICAL PRACTICE More critical care nurses are realizing the need for bereavement follow-up guidelines. This paper provides an overview of common elements that might be considered. WHAT IS KNOWN ABOUT THIS TOPIC Many families experience the death of a loved one in intensive care unit (ICU). Bereavement services are offered at some ICUs. WHAT THIS PAPER ADDS Bereavement services are not systematically offered in European ICUs. Culture-specific guidelines are needed for bereavement follow up in ICUs. Common elements of bereavement services have been identified, for example, viewing the deceased in the unit, providing follow-up information, sending a letter of sympathy, and calling the family to arrange a meeting. Consequences of bereavement in ICU have been discussed, for example, prolonged or complicated grief and lack of closure in the bereaved.
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Affiliation(s)
- Ingrid Egerod
- Rigshospitalet, Intensive Care Unit 4131, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Kaldan
- Centre for Cancer and Organ Diseases, Research Unit 7831, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - John Albarran
- Critical and Cardiovascular Nursing, Nursing in Critical Care
| | - Maureen Coombs
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - Marion Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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Erikson A, Puntillo K, McAdam J. Family members' opinions about bereavement care after cardiac intensive care unit patients' deaths. Nurs Crit Care 2019; 24:209-221. [DOI: 10.1111/nicc.12439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Alyssa Erikson
- Department of NursingCalifornia State University Monterey Bay, Seaside California
| | - Kathleen Puntillo
- Department of NursingUniversity of California San Francisco California
| | - Jennifer McAdam
- Department of NursingSamuel Merritt University Oakland California
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Hua M. Psychological Outcomes after Critical Illness. Is It Time to Rethink Our Paradigm? Am J Respir Crit Care Med 2019; 197:6-7. [PMID: 28968149 DOI: 10.1164/rccm.201709-1885ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- May Hua
- 1 Department of Anesthesiology Columbia University New York, New York
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66
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The state of bereavement support in adult intensive care: A systematic review and narrative synthesis. J Crit Care 2019; 50:177-187. [DOI: 10.1016/j.jcrc.2018.11.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/12/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022]
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Imanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. Family members' experiences in adult intensive care units: a systematic review. Scand J Caring Sci 2019; 33:569-581. [PMID: 30866085 DOI: 10.1111/scs.12675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases. AIM This review sought to describe the experiences of family members of patients admitted in adult ICUs. DATA SOURCES Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words. METHODS Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). RESULTS Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure. CONCLUSION As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.
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Affiliation(s)
- Masoomeh Imanipour
- Nursing and Midwifery Care Research Center.,Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Frank Kiwanuka
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | | | - Ronald Masaba
- School of Nursing, Clarke International University, Kampala, Uganda
| | - Yisak Hagos Alemayehu
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Ayder Comprehensive Specialized Hospital, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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DeSanto-Madeya S, Willis D, McLaughlin J, Boslet A. Healing experience for family caregivers after an intensive care unit death. BMJ Support Palliat Care 2019; 12:e578-e584. [PMID: 30723073 DOI: 10.1136/bmjspcare-2018-001561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 01/02/2019] [Accepted: 01/16/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Family caregivers suffer a high burden of emotional and psychological distress following the death of a loved one in the intensive care unit and often struggle to heal in the weeks following their loss. The purpose of this hermeneutic phenomenological study was to describe and interpret the experience of healing for family caregivers six weeks following the death of a loved one in the ICU. METHODS Semi-structured telephone interviews were conducted with a purposive sample of twenty-four family caregivers six weeks following the death of their loved ones in the ICU. Qualitative analysis techniques were used to identify common themes central to the experience of healing across all interviews. RESULTS Seven themes were interpreted from the data: searching for clarity from a time of uncertainty; riding an emotional rollercoaster; seeking peace in one's decisions; moving forward with each new day; taking comfort in the memories; valuing layers of support; and discovering life on one's own. CONCLUSION By identifying and gaining an understanding of healing following the death of a loved one in the ICU, nursing and other healthcare providers have an opportunity to promote healing and positively impact family caregiver's bereavement.
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Affiliation(s)
- Susan DeSanto-Madeya
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA .,Patient Care Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dan Willis
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julie McLaughlin
- Medical Associates of Greater Boston, Natick, Massachusetts, USA
| | - Aristotle Boslet
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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69
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Focus on randomised clinical trials. Intensive Care Med 2018; 44:2257-2259. [PMID: 30443730 DOI: 10.1007/s00134-018-5468-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
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70
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Azoulay E, Forel JM, Vinatier I, Truillet R, Renault A, Valade S, Jaber S, Durand-Gasselin J, Schwebel C, Georges H, Merceron S, Cariou A, Moussa M, Hraiech S, Argaud L, Leone M, Curtis JR, Kentish-Barnes N, Jouve E, Papazian L. Questions to improve family-staff communication in the ICU: a randomized controlled trial. Intensive Care Med 2018; 44:1879-1887. [PMID: 30374690 DOI: 10.1007/s00134-018-5423-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/17/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Relatives of intensive care unit (ICU) patients suffer emotional distress that impairs their ability to acquire the information they need from the staff. We sought to evaluate whether providing relatives with a list of important questions was associated with better comprehension on day 5. METHODS Randomized, parallel-group trial. Relatives of mechanically ventilated patients were included from 14 hospitals belonging to the FAMIREA study group in France. A validated list of 21 questions was handed to the relatives immediately after randomization. The primary endpoint was comprehension on day 5. Secondary endpoints were satisfaction (Critical Care Family Needs Inventory, CCFNI) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale, HADS). RESULTS Of 394 randomized relatives, 302 underwent the day-5 assessment of all outcomes. Day-5 family comprehension was adequate in 68 (44.2%) and 75 (50.7%) intervention and control group relatives (P = 0.30), respectively. Over the first five ICU days, median number of family-staff meetings/patient was 6 [3-9], median total meeting time was 72.5 [35-110] min, and relatives asked a median of 20 [8-33] questions including 11 [6-13] from the list, with no between-group difference. Satisfaction and anxiety/depression symptoms were not significantly different between groups. The only variable significantly associated with better day-5 comprehension by multivariable analysis was a higher total number of questions asked before day 5. CONCLUSIONS Providing relatives with a list of questions did not improve day-5 comprehension, secondary endpoints, or information time. Further research is needed to help families obtain the information they need. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02410538.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| | | | - Isabelle Vinatier
- Surgical ICUs From Montpellier or Marseille Hospitals, Medical-Surgical ICUs From La Roche sur Yon, La Roche sur Yon, France
| | - Romain Truillet
- Statistical Department of Marseille, AP-HM, Marseille, France
| | | | - Sandrine Valade
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Samir Jaber
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | | | | | | | | | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France
| | | | | | | | - Marc Leone
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA
| | - Nancy Kentish-Barnes
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Elisabeth Jouve
- Statistical Department of Marseille, AP-HM, Marseille, France
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Abstract
PURPOSE OF REVIEW End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. RECENT FINDINGS EOL care is a risk factor for clinician burnout; poor work conditions contribute to emotional exhaustion and intent to leave. The impact of EOL care on families is part of the acute Family Intensive Care Unit Syndrome (FICUS) and the Post Intensive Care Syndrome-Family (PICS-F). Family-centered care (FCC) acknowledges the importance of relatives in the ICU. Several interventions have been evaluated, but evidence for their effectiveness is at best moderate. Some interventions even increased family stress. Interventional studies, which address clinician burnout are rare. SUMMARY EOL care is associated with negative outcomes for ICU clinicians and relatives, but strength of evidence for interventions is weak because we lack understanding of associated factors like work conditions, organizational issues or individual attitudes. In order to develop complex interventions that can successfully mitigate stress related to EOL care, more research is necessary, which takes into account all potential determinants.
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72
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McAdam JL, Puntillo K. Pilot Study Assessing the Impact of Bereavement Support on Families of Deceased Intensive Care Unit Patients. Am J Crit Care 2018; 27:372-380. [PMID: 30173170 DOI: 10.4037/ajcc2018575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of patients who die in an intensive care unit (ICU) may experience negative outcomes. However, few studies have assessed the effectiveness of bereavement care for families. OBJECTIVE To evaluate the effectiveness of bereavement follow-up on family members' anxiety, depression, posttraumatic stress, prolonged grief, and satisfaction with care. METHODS A cross-sectional, prospective pilot study of 40 family members of patients who died in 2 tertiary care ICUs. Those in the medical-surgical ICU received bereavement follow-up (bereavement group); those in the cardiac ICU received standard care (nonbereavement group). Both groups completed surveys 13 months after the death. Surveys included the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Family Satisfaction With Care in the Intensive Care Unit, Prolonged Grief Disorder, and a bereavement survey. RESULTS Of 30 family members in the bereavement group and 10 in the nonbereavement group, most were female and spouses, with a mean (SD) age of 60.1 (13.3) years. Significantly more participants in the nonbereavement group than in the bereavement group had prolonged grief. Posttraumatic stress, anxiety, depression, and satisfaction with care were not significantly different in the 2 groups. However, overall posttraumatic stress scores were higher in the nonbereavement group than the bereavement group, indicating a higher risk of posttraumatic stress disorder. CONCLUSIONS Bereavement follow-up after an ICU death reduced family members' prolonged grief and may also reduce their risk of posttraumatic stress disorder. This type of support did not have a measurable effect on depression or satisfaction with ICU care.
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Affiliation(s)
- Jennifer L. McAdam
- Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, San Francisco, California
| | - Kathleen Puntillo
- Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, San Francisco, California
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73
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Abstract
BACKGROUND Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). METHODS We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds. Between March and October, 2015, surveys were mailed to family members of patients discharged from the neuro-ICU. RESULTS Nearly half of surveys (n = 91, 48.1%) were returned at a median of 4.7 months. At the time of survey completion, mean Modified rankin scale score (mRS) of neuro-ICU patients was 3.1 (SD 2). Overall ratings of quality of care were relatively high (82.2 on a 0-100 scale) with 32% of family members meeting screening criteria for depressive syndrome. The primary outcome measuring family satisfaction, consisting of eight items from the Family Satisfaction in the ICU questionnaire, did not differ significantly between families of patients from either ICU service nor did family ratings of depression (PHQ-8) and post-traumatic stress (PCL-17). CONCLUSIONS Among families of patients discharged from the neuro-ICU, the daily use of a palliative care needs checklist had no measurable effect on family satisfaction scores or long-term psychological outcomes. Further research is needed to identify optimal interventions to meet the palliative care needs specific to family members of patients treated in the neuro-ICU.
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74
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Egerod I, Kaldan G, Coombs M, Mitchell M. Family-centered bereavement practices in Danish intensive care units: a cross-sectional national survey. Intensive Crit Care Nurs 2018; 45:52-57. [DOI: 10.1016/j.iccn.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/08/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
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75
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Kitzmiller L, Kline-Tilford AM. Supporting the family left behind – Loss of a child to congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodríguez-Álvaro M, García-Hernández AM, Brito-Brito PR, Aguirre-Jaime A, Fernández-Gutiérrez DÁ. Bereavement care interventions and outcome criteria planned by community nurses in the Canary Islands. ENFERMERIA CLINICA 2018; 28:S1130-8621(17)30194-8. [PMID: 29472159 DOI: 10.1016/j.enfcli.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/16/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
Nursing care in bereavement is complex. Primary health care is the ideal setting to support the bereaved, but we do not know much about the care plans designed by primary health care nurses in the treatment of grief. OBJECTIVE To identify the outcomes criteria and interventions planned by nurses for mourners with and without complications in the Canary Islands. METHOD Retrospective longitudinal study, using the electronic health records of the Canary Islands health service of people with a diagnosis of grieving, risk of complicated grieving and complicated grieving, in the period 2009-2014. RESULTS NOC outcomes criteria were recorded in 67% of the mourners, and up to 24 different outcomes were identified. The main outcomes measures were Grief resolution; Psychosocial adjustment, Life change; Coping; Family coping; Family social climate and Caregiver emotional health. The remaining outcomes were present in less than 1% of the mourners. Although the outcomes criteria proposed by nurses in the mourners with and without complications were quite homogeneous, differences in interventions were found. In 67% of the cases, NIC interventions were reported. Ninety-nine different interventions were identified in the mourners; the most frequent were Emotional support; Grief work facilitation; Active listening; Coping enhancement and counselling. The remaining identified interventions were present in less than 5% of patients. The main interventions in the mourners with complications were Grief work facilitation; Coping enhancement; Active listening; Counselling and Family integrity promotion. CONCLUSION Nurses state that there are more interventions and outcomes in mourners with complications. Given the few methodologically reliable studies that prove their effectiveness, continued research in this area is recommended.
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Affiliation(s)
- Martín Rodríguez-Álvaro
- Gerencia del Área de Salud de La Palma, Servicio Canario de la Salud, La Palma, España; Grupo de investigación, Universidad de La Laguna "Cuidados al Final de la Vida (CUFINVIDA)", Tenerife, España.
| | - Alfonso Miguel García-Hernández
- Universidad de La Laguna, Tenerife, España; Grupo de investigación, Universidad de La Laguna "Cuidados al Final de la Vida (CUFINVIDA)", Tenerife, España
| | - Pedro Ruymán Brito-Brito
- Unidad de Formación e Investigación en Cuidados, Gerencia de Atención Primaria, Servicio Canario de la Salud, Tenerife, España; Grupo de investigación, Universidad de La Laguna "Cuidados al Final de la Vida (CUFINVIDA)", Tenerife, España
| | - Armando Aguirre-Jaime
- Unidad de Investigación Clínico-Quirúrgica, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Domingo Ángel Fernández-Gutiérrez
- Unidad de Formación e Investigación en Cuidados, Gerencia de Atención Primaria, Servicio Canario de la Salud, Tenerife, España; Grupo de investigación, Universidad de La Laguna "Cuidados al Final de la Vida (CUFINVIDA)", Tenerife, España
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Wang S, Allen D, Kheir YN, Campbell N, Khan B. Aging and Post-Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry. Am J Geriatr Psychiatry 2018; 26:212-221. [PMID: 28716375 PMCID: PMC5711627 DOI: 10.1016/j.jagp.2017.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 01/31/2023]
Abstract
Because of the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments because of critical illness, known as post-intensive care syndrome (PICS). This article focuses on PICS-related cognitive, psychological, and physical impairments and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS and what roles geriatric psychiatrists could play in the future of this rapidly growing population.
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Affiliation(s)
- Sophia Wang
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN; Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN.
| | - Duane Allen
- Department of Internal Medicine, and Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - You Na Kheir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Noll Campbell
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN; Department of Pharmacy Practice, Purdue University School of Pharmacy, West Lafayette, IN; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN
| | - Babar Khan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN
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Azoulay E, Vincent JL, Angus DC, Arabi YM, Brochard L, Brett SJ, Citerio G, Cook DJ, Curtis JR, Dos Santos CC, Ely EW, Hall J, Halpern SD, Hart N, Hopkins RO, Iwashyna TJ, Jaber S, Latronico N, Mehta S, Needham DM, Nelson J, Puntillo K, Quintel M, Rowan K, Rubenfeld G, Van den Berghe G, Van der Hoeven J, Wunsch H, Herridge M. Recovery after critical illness: putting the puzzle together-a consensus of 29. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:296. [PMID: 29208005 PMCID: PMC5718148 DOI: 10.1186/s13054-017-1887-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023]
Abstract
In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of family-centered care. This consensus of 29 also provides a perspective and a research agenda about post-ICU recovery.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA team, Biostatistics and clinical epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| | | | - Derek C Angus
- The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yaseen M Arabi
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Stephen J Brett
- Department of Surgery and Cancer Imperial College, London, UK
| | | | - Deborah J Cook
- McMaster University Medical Center, Hamilton, ON, Canada
| | | | | | - E Wesley Ely
- Vanderbilt University School of Medicine, and TN Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Jesse Hall
- The University of Chicago, Chicago, IL, USA
| | | | | | - Ramona O Hopkins
- Intermountain Medical Center, Murray, UT, USA.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Theodore J Iwashyna
- University of Michigan Health System, and Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| | | | | | | | - Dale M Needham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judith Nelson
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College New York, New York, NY, USA
| | | | | | - Kathy Rowan
- Intensive Care National Audit & Research Centre, London, UK
| | | | | | | | - Hannah Wunsch
- Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Margaret Herridge
- Toronto General Research Institute, University of Toronto, UHN - University Health Network, Toronto, ON, Canada
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80
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Long AC, Curtis JR. Aligning Intention and Effect: What Can We Learn From Family Members' Responses to Condolence Letters? Crit Care Med 2017; 45:2099-2100. [PMID: 29148986 PMCID: PMC5726427 DOI: 10.1097/ccm.0000000000002738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ann C. Long
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview
Medical Center, University of Washington, Seattle, WA,Cambia Palliative Care Center of Excellence, University of
Washington, Seattle WA
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview
Medical Center, University of Washington, Seattle, WA,Cambia Palliative Care Center of Excellence, University of
Washington, Seattle WA
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81
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Curtis JR, Sathitratanacheewin S, Starks H, Lee RY, Kross EK, Downey L, Sibley J, Lober W, Loggers ET, Fausto JA, Lindvall C, Engelberg RA. Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges. J Palliat Med 2017; 21:S52-S60. [PMID: 29182487 DOI: 10.1089/jpm.2017.0542] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure and benchmark care of the seriously ill, including the delivery of both primary care and specialty palliative care. Such metrics can be used to drive quality improvement, value-based payment, and accountability for population-based outcomes. METHODS In this article, we examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system. RESULTS In the search for feasible, reliable, and valid palliative care quality metrics, the EHR is an attractive option for collecting quality data on large numbers of seriously ill patients. However, important challenges to using EHR data for quality improvement and accountability exist, including understanding the validity, reliability, and completeness of the data, as well as acknowledging the difference between care documented and care delivered. Challenges also include developing achievable metrics that are clearly linked to patient and family outcomes and addressing data interoperability across sites as well as EHR platforms and vendors. This article summarizes the strengths and weakness of the EHR as a data source for accountability of community- and population-based programs for serious illness, describes the implementation of EHR data in the palliative care quality metrics program at the University of Washington, and, based on that experience, discusses opportunities and challenges. Our palliative care metrics program was designed to serve as a resource for other healthcare systems. DISCUSSION Although the EHR offers great promise for enhancing quality of care provided for the seriously ill, significant challenges remain to operationalizing this promise on a national scale and using EHR data for population-based quality and accountability.
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Affiliation(s)
- J Randall Curtis
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, Washington.,3 Department of Bioethics and Humanities, University of Washington , Seattle, Washington
| | - Seelwan Sathitratanacheewin
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, Washington
| | - Helene Starks
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,3 Department of Bioethics and Humanities, University of Washington , Seattle, Washington.,4 Department of Family Medicine, University of Washington , Seattle, Washington
| | - Robert Y Lee
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, Washington
| | - Erin K Kross
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, Washington
| | - Lois Downey
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, Washington
| | - James Sibley
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,5 Department of Bioinformatics and Medical Education, University of Washington , Seattle, Washington
| | - William Lober
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,5 Department of Bioinformatics and Medical Education, University of Washington , Seattle, Washington
| | - Elizabeth T Loggers
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,6 Seattle Cancer Care Alliance , Seattle, Washington.,7 Clinical Research Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - James A Fausto
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,4 Department of Family Medicine, University of Washington , Seattle, Washington
| | - Charlotta Lindvall
- 8 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Ruth A Engelberg
- 1 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington.,2 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, Washington
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82
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Turnbull AE, Chessare CM, Coffin RK, Needham DM. A brief intervention for preparing ICU families to be proxies: A phase I study. PLoS One 2017; 12:e0185483. [PMID: 28968409 PMCID: PMC5624606 DOI: 10.1371/journal.pone.0185483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022] Open
Abstract
Background Family members of critically ill patients report high levels of conflict with clinicians, have poor understanding of prognosis, struggle to make decisions, and experience substantial symptoms of anxiety, depression, and post-traumatic stress regardless of patient survival status. Efficient interventions are needed to prepare these families to act as patient proxies. Objectives To assess a brief “patient activation” intervention designed to set expectations and prepare families of adult intensive care unit (ICU) patients to communicate effectively with the clinical team. Design Phase I study of acceptability and immediate side effects. Setting and participants 122 healthcare proxies of 111 consecutive patients with a stay of ≥24 hours in the Johns Hopkins Hospital Medical ICU (MICU), in Baltimore, Maryland. Intervention Reading aloud to proxies from a booklet (Flesch-Kincard reading grade level 3.8) designed with multidisciplinary input including from former MICU proxies. Results Enrolled proxies had a median age of 51 years old with 83 (68%) female, and 55 (45%) African-American. MICU mortality was 18%, and 37 patients (33%) died in hospital or were discharged to hospice. Among proxies 98% (95% CI: 94% - 100%) agreed or strongly agreed that the intervention was appropriate, 98% (95% CI: 92% - 99%) agreed or strongly agreed that it is important for families to know the information in the booklet, and 54 (44%, 95% CI 35%– 54%) agreed or strongly agreed that parts of the booklet are upsetting. Upset vs. non-upset proxies were not statistically or substantially different in terms of age, sex, education level, race, relation to the patient, or perceived decision-making authority. Conclusions This patient activation intervention was acceptable and important to nearly all proxies. Frequently, the intervention was simultaneously rated as both acceptable/important and upsetting. Proxies who rated the intervention as upsetting were not identifiable based on readily available proxy or patient characteristics.
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Affiliation(s)
- Alison E. Turnbull
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, United States of America
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Caroline M. Chessare
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, United States of America
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rachel K. Coffin
- Medical Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, United States of America
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
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83
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Courtright KR, Benoit DD, Halpern SD. Life after death in the ICU: detecting family-centered outcomes remains difficult. Intensive Care Med 2017; 43:1529-1531. [PMID: 28936617 DOI: 10.1007/s00134-017-4898-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Katherine R Courtright
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Scott D Halpern
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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84
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Brown CE, Benoit DD, Curtis JR. Focus on palliative care in the ICU. Intensive Care Med 2017; 43:1898-1900. [PMID: 28932878 DOI: 10.1007/s00134-017-4938-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Crystal E Brown
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Box 359762, Seattle, WA, 98104, USA
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Box 359762, Seattle, WA, 98104, USA.
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New developments in the provision of family-centered care in the intensive care unit. Intensive Care Med 2017; 43:550-553. [PMID: 28124085 PMCID: PMC5359380 DOI: 10.1007/s00134-017-4684-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/15/2022]
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