1
|
Hayes K, Harding S, Blackwood B, Latour JM. How and when post intensive care syndrome-family is measured: A scoping review. Intensive Crit Care Nurs 2024; 84:103768. [PMID: 39079481 DOI: 10.1016/j.iccn.2024.103768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/22/2024] [Accepted: 07/06/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Family members of Intensive Care Unit (ICU) patients can experience mental health difficulties. These are collectively described as Post Intensive Care Syndrome-Family (PICS-F). There are no standardised outcome measures to benchmark the impact of PICS-F. This scoping review aimed to map and characterise interventions, outcomes, and outcome instruments related to PICS-F. METHODS Eight databases were searched in June 2023: Pubmed, CINAHL, Ovid Medline, EMBASE, PsycInfo, AMED, Emcare and Cochrane. The grey literature was also searched. Studies published after 2012 related to PICS-F were included. Search strategy included: (Population) family members of adult ICU patients, (Concept) PICS-F, (Context) ICU settings. Frequency analysis of outcomes was performed, and instruments were mapped to describe the characteristics. RESULTS Of the identified 4848 records, 46 papers representing 44 unique studies met the inclusion criteria and were retained for analysis. In total, 8008 family members were represented across 15 countries in four continents worldwide. The number of studies reporting PICS-F interventions increased rapidly over the past 12 years and were performed in ICUs treating mixed conditions. Studies were randomised control trials (n = 33), before-and-after design (n = 6) and non-randomised trials (n = 5). A total of 18 outcome instruments were used measuring predominantly anxiety, with complicated grief measured only once. The identified instruments were mostly validated for clinical and disease specific populations but not validated among relatives of ICU patients. CONCLUSION There is a plethora of instruments measuring PICS-F outcomes. No core outcome set is currently available for PICS-F. To reduce heterogeneity of how PICS-F is measured, a core outcome set with validated measurements is recommended to allow benchmarking and to document the impact of PICS-F interventions. IMPLICATIONS FOR CLINICAL PRACTICE Recognising PICS-F symptoms and understanding how to assess them could help clinicians to develop interventions to improve family outcomes. Validated instruments are needed to evaluate these interventions.
Collapse
Affiliation(s)
- Kati Hayes
- Research and Development Department, North Bristol NHS Trust, Westbury On Trym, Bristol, UK.
| | - Sam Harding
- Research and Development Department, North Bristol NHS Trust, Westbury On Trym, Bristol, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Northern Ireland, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia; Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Amacher SA, Gross S, Becker C, Arpagaus A, Urben T, Gaab J, Emsden C, Tisljar K, Sutter R, Pargger H, Marsch S, Hunziker S. Misconceptions and do-not-resuscitate preferences of healthcare professionals commonly involved in cardiopulmonary resuscitations: A national survey. Resusc Plus 2024; 17:100575. [PMID: 38375442 PMCID: PMC10875294 DOI: 10.1016/j.resplu.2024.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Aims To assess the DNR preferences of critical care-, anesthesia- and emergency medicine practitioners, to identify factors influencing decision-making, and to raise awareness for misconceptions concerning CPR outcomes. Methods A nationwide multicenter survey was conducted in Switzerland confronting healthcare professionals with a case vignette of an adult patient with an out-of-hospital cardiac arrest (OHCA). The primary outcome was the rate of DNR Code Status vs. CPR Code Status when taking the perspective from a clinical case vignette of a 70-year-old patient. Secondary outcomes were participants' personal preferences for DNR and estimates of survival with good neurological outcome after in- and out-of-hospital cardiac arrest. Results Within 1803 healthcare professionals, DNR code status was preferred in 85% (n = 1532) in the personal perspective of the case vignette and 53.2% (n = 932) when making a decision for themselves. Main predictors for a DNR Code Status regarding the case vignette included preferences for DNR Code Status for themselves (n [%] 896 [58.5] vs. 87 [32.1]; adjusted odds ratio [OR] 2.97, 95% confidence interval [CI] 2.25-3.92; p < 0.001) and lower estimated OHCA survival (mean [±SD] 12.3% [±11.8] vs. 14.7%[±12.8]; adjusted OR 0.98, 95% CI 0.97-0.99; p = 0.001). Physicians chose a DNR order more often when compared to nurses and paramedics. Conclusions The estimation of outcomes following cardiac arrest and personal living conditions are pivotal factors influencing code status preferences in healthcare professionals. Healthcare professionals should be aware of cardiac arrest prognosis and potential implications of personal preferences when engaging in code status- and end-of-life discussions with patients and their relatives.
Collapse
Affiliation(s)
- Simon A. Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Armon Arpagaus
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christian Emsden
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Dupont T, Kentish-Barnes N, Pochard F, Duchesnay E, Azoulay E. Prediction of post-traumatic stress disorder in family members of ICU patients: a machine learning approach. Intensive Care Med 2024; 50:114-124. [PMID: 38112774 DOI: 10.1007/s00134-023-07288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Post-traumatic stress disorder (PTSD) can affect family members of patients admitted to the intensive care unit (ICU). Easily accessible patient's and relative's information may help develop accurate risk stratification tools to direct relatives at higher risk of PTSD toward appropriate management. METHODS PTSD was measured 90 days after ICU discharge using validated instruments (Impact of Event Scale and Impact of Event Scale-Revised) in 2374 family members. Various supervised machine learning approaches were used to predict PTSD in family members and evaluated on an independent held-out test dataset. To better understand variables' contributions to PTSD predicted probability, we used machine learning interpretability methods on the best predictive algorithm. RESULTS Non-linear ensemble learning tree-based methods showed better predictive performances (Random Forest-area under curve, AUC = 0.73 [0.68-0.77] and XGBoost-AUC = 0.73 [0.69-0.78]) than regularized linear models, kernel-based models, or deep learning models. In the best performing algorithm, most important features that positively contributed to PTSD's predicted probability were all non-modifiable factors, namely, lower patient's age, longer duration of ICU stay, relative's female sex, lower relative's age, relative being a spouse/child, and patient's death in ICU. A sensitivity analysis in bereaved relatives did not alter the algorithm's predictive performance. CONCLUSION We propose a machine learning-based approach to predict PTSD in relatives of ICU patients at an individual level. In this model, PTSD is mostly influenced by non-modifiable factors.
Collapse
Affiliation(s)
- Thibault Dupont
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-Sur-Yvette, France
- Famirea Study Group, Médecine Intensive et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Université Paris Cité, Paris, France
| | - Nancy Kentish-Barnes
- Famirea Study Group, Médecine Intensive et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
- Université Paris Cité, Paris, France
| | - Frédéric Pochard
- Famirea Study Group, Médecine Intensive et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Edouard Duchesnay
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-Sur-Yvette, France
| | - Elie Azoulay
- Famirea Study Group, Médecine Intensive et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
- Université Paris Cité, Paris, France.
| |
Collapse
|
4
|
Wang G, Antel R, Goldfarb M. The Impact of Randomized Family-Centered Interventions on Family-Centered Outcomes in the Adult Intensive Care Unit: A Systematic Review. J Intensive Care Med 2023:8850666231173868. [PMID: 37161268 DOI: 10.1177/08850666231173868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective: To review the literature for randomized family-centered interventions with family-centered outcomes in the adult intensive care unit (ICU). Data Sources: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library database from inception until February 2023. Study Selection: We included articles involving randomized controlled trials (RCTs) in the adult critical care setting evaluating family-centered interventions and reporting family-centered outcomes. Data Extraction: We extracted data on author, year of publication, setting, number of participants, intervention category, intervention, and family-centered outcomes. Data Synthesis: There were 52 RCTs included in the analysis, mostly involving communication and receiving information (38%) and receiving care and meeting family member needs (38%). Nearly two-thirds of studies (N = 35; 67.3%) found improvements in at least 1 family-centered outcome. Most studies (N = 24/40; 60%) exploring the impact of family-centered interventions on mental health outcomes showed improvement. Improvements in patient-centered outcomes (N = 7/17; 41%) and healthcare worker outcomes (N = 1/5; 20%) were less commonly found. Conclusions: Family-centered interventions improve family-centered outcomes in the adult ICU and may be beneficial to patients and healthcare workers.
Collapse
Affiliation(s)
- Gary Wang
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ryan Antel
- McGill Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
5
|
Reifarth E, Garcia Borrega J, Kochanek M. How to communicate with family members of the critically ill in the intensive care unit: A scoping review. Intensive Crit Care Nurs 2023; 74:103328. [PMID: 36180318 DOI: 10.1016/j.iccn.2022.103328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits. METHODS We conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding. RESULTS The search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs. CONCLUSION The current approaches to communication with patients' family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.
Collapse
Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Faculty of Medicine, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| |
Collapse
|
6
|
Le Dorze M, Martouzet S, Cassiani-Ingoni E, Roussin F, Mebazaa A, Morin L, Kentish-Barnes N. “A Delicate balance”—Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study. Transpl Int 2022; 35:10648. [PMID: 36148004 PMCID: PMC9485469 DOI: 10.3389/ti.2022.10648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022]
Abstract
Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs. However, healthcare professionals may feel uncomfortable as end-of-life care and organ donation overlap in cDCD, creating a potential barrier to its development. The aim of this qualitative study was to gain insight on the perceptions and experiences of intensive care units (ICU) physicians and nurses regarding cDCD. We used thematic analysis of in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. 17 staff members (8 physicians and 9 nurses) participated in the study. Analysis showed a gap between ethical principles and routine clinical practice, with a delicate balance between end-of-life care and organ donation. This tension arises at three critical moments: during the decision-making process leading to the withdrawal of life-sustaining treatments (LST), during the period between the decision to withdraw LST and its actual implementation, and during the dying and death process. Our findings shed light on the strategies developed by healthcare professionals to solve these ethical tensions and to cope with the emotional ambiguities. cDCD implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.
Collapse
Affiliation(s)
- Matthieu Le Dorze
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
- Université Paris-Saclay, UVSQ, INSERM, CESP, U1018, Villejuif, France
- *Correspondence: Matthieu Le Dorze,
| | - Sara Martouzet
- Université de Tours, EA 7505 Éducation, Éthique et Santé, Tours, France
| | - Etienne Cassiani-Ingoni
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
| | - France Roussin
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
| | - Alexandre Mebazaa
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
- Université de Paris, Inserm, UMRS 942 Mascot, Paris, France
| | - Lucas Morin
- INSERM CIC 1431, University Hospital of Besançon, Besançon, France
| | - Nancy Kentish-Barnes
- AP-HP, Saint Louis University Hospital, Famiréa Research Group, Medical Intensive Care Unit, Paris, France
| |
Collapse
|
7
|
Allum L, Apps C, Pattison N, Connolly B, Rose L. Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools. Intensive Crit Care Nurs 2022; 73:103302. [PMID: 35931596 DOI: 10.1016/j.iccn.2022.103302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay. RESEARCH METHODOLOGY Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022). RESULTS We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium. CONCLUSION Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required. SYSTEMATIC REVIEW REGISTRATION The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.
Collapse
Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Chloe Apps
- Critical Care Research Group and Physiotherapy Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Rd, London SE1 7EH, UK.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| |
Collapse
|
8
|
Ryan RE, Connolly M, Bradford NK, Henderson S, Herbert A, Schonfeld L, Young J, Bothroyd JI, Henderson A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev 2022; 7:CD013116. [PMID: 35802350 PMCID: PMC9266997 DOI: 10.1002/14651858.cd013116.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Communication about end of life (EoL) and EoL care is critically important for providing quality care as people approach death. Such communication is often complex and involves many people (patients, family members, carers, health professionals). How best to communicate with people in the period approaching death is not known, but is an important question for quality of care at EoL worldwide. This review fills a gap in the evidence on interpersonal communication (between people and health professionals) in the last year of life, focusing on interventions to improve interpersonal communication and patient, family member and carer outcomes. OBJECTIVES To assess the effects of interventions designed to improve verbal interpersonal communication about EoL care between health practitioners and people affected by EoL. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL from inception to July 2018, without language or date restrictions. We contacted authors of included studies and experts and searched reference lists to identify relevant papers. We searched grey literature sources, conference proceedings, and clinical trials registries in September 2019. Database searches were re-run in June 2021 and potentially relevant studies listed as awaiting classification or ongoing. SELECTION CRITERIA This review assessed the effects of interventions, evaluated in randomised and quasi-randomised trials, intended to enhance interpersonal communication about EoL care between patients expected to die within 12 months, their family members and carers, and health practitioners involved in their care. Patients of any age from birth, in any setting or care context (e.g. acute catastrophic injury, chronic illness), and all health professionals involved in their care were eligible. All communication interventions were eligible, as long as they included interpersonal interaction(s) between patients and family members or carers and health professionals. Interventions could be simple or complex, with one or more communication aims (e.g. to inform, skill, engage, support). Effects were sought on outcomes for patients, family and carers, health professionals and health systems, including adverse (unintended) effects. To ensure this review's focus was maintained on interpersonal communication in the last 12 months of life, we excluded studies that addressed specific decisions, shared or otherwise, and the tools involved in such decision-making. We also excluded studies focused on advance care planning (ACP) reporting ACP uptake or completion as the primary outcome. Finally, we excluded studies of communication skills training for health professionals unless patient outcomes were reported as primary outcomes. DATA COLLECTION AND ANALYSIS Standard Cochrane methods were used, including dual review author study selection, data extraction and quality assessment of the included studies. MAIN RESULTS Eight trials were included. All assessed intervention effects compared with usual care. Certainty of the evidence was low or very low. All outcomes were downgraded for indirectness based on the review's purpose, and many were downgraded for imprecision and/or inconsistency. Certainty was not commonly downgraded for methodological limitations. A summary of the review's findings is as follows. Knowledge and understanding (four studies, low-certainty evidence; one study without usable data): interventions to improve communication (e.g. question prompt list, with or without patient and physician training) may have little or no effect on knowledge of illness and prognosis, or information needs and preferences, although studies were small and measures used varied across trials. Evaluation of the communication (six studies measuring several constructs (communication quality, patient-centredness, involvement preferences, doctor-patient relationship, satisfaction with consultation), most low-certainty evidence): across constructs there may be minimal or no effects of interventions to improve EoL communication, and there is uncertainty about effects of interventions such as a patient-specific feedback sheet on quality of communication. Discussions of EoL or EoL care (six studies measuring selected outcomes, low- or very low-certainty evidence): a family conference intervention may increase duration of EoL discussions in an intensive care unit (ICU) setting, while use of a structured serious illness conversation guide may lead to earlier discussions of EoL and EoL care (each assessed by one study). We are uncertain about effects on occurrence of discussions and question asking in consultations, and there may be little or no effect on content of communication in consultations. Adverse outcomes or unintended effects (limited evidence): there is insufficient evidence to determine whether there are adverse outcomes associated with communication interventions (e.g. question prompt list, family conference, structured discussions) for EoL and EoL care. Patient and/or carer anxiety was reported by three studies, but judged as confounded. No other unintended consequences, or worsening of desired outcomes, were reported. Patient/carer quality of life (four studies, low-certainty evidence; two without useable data): interventions to improve communication may have little or no effect on quality of life. Health practitioner outcomes (three studies, low-certainty evidence; two without usable data): interventions to improve communication may have little or no effect on health practitioner outcomes (satisfaction with communication during consultation; one study); effects on other outcomes (knowledge, preparedness to communicate) are unknown. Health systems impacts: communication interventions (e.g. structured EoL conversations) may have little or no effect on carer or clinician ratings of quality of EoL care (satisfaction with care, symptom management, comfort assessment, quality of care) (three studies, low-certainty evidence), or on patients' self-rated care and illness, or numbers of care goals met (one study, low-certainty evidence). Communication interventions (e.g. question prompt list alone or with nurse-led communication skills training) may slightly increase mean consultation length (two studies), but other health service impacts (e.g. hospital admissions) are unclear. AUTHORS' CONCLUSIONS Findings of this review are inconclusive for practice. Future research might contribute meaningfully by seeking to fill gaps for populations not yet studied in trials; and to develop responsive outcome measures with which to better assess the effects of communication on the range of people involved in EoL communication episodes. Mixed methods and/or qualitative research may contribute usefully to better understand the complex interplay between different parties involved in communication, and to inform development of more effective interventions and appropriate outcome measures. Co-design of such interventions and outcomes, involving the full range of people affected by EoL communication and care, should be a key underpinning principle for future research in this area.
Collapse
Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin and Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Natalie K Bradford
- Centre for Children's Health Research, Cancer and Palliative Care Outcomes at Centre for Children's Health Research, Queensland University of Technology (QUT), South Brisbane, Australia
| | - Simon Henderson
- Department of Aviation, The University of New South Wales, Sydney, Australia
| | - Anthony Herbert
- Paediatric Palliative Care Service, Children's Health Queensland, Hospital and Health Service, South Brisbane, Australia
- Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | | | - Amanda Henderson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| |
Collapse
|
9
|
Langer T, Depalo FC, Forlini C, Landini S, Mezzetti A, Previtali P, Monti G, de Toma C, Biscardi D, Giannini A, Fumagalli R, Mistraletti G. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey. BMC Anesthesiol 2022; 22:187. [PMID: 35710331 PMCID: PMC9203262 DOI: 10.1186/s12871-022-01726-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/09/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. METHODS A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. RESULTS Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. CONCLUSIONS Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.
Collapse
Affiliation(s)
- Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Francesca Carmela Depalo
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Clarissa Forlini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Silvia Landini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | | - Paola Previtali
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Carolina de Toma
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Davide Biscardi
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
| | - Giovanni Mistraletti
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Drury A, Muscat DM, Wibrow B, Jacques A, Anstey M. Integrating the Choosing Wisely 5 Questions into Family Meetings in the Intensive Care Unit: A Randomized Controlled Trial Investigating the Effect on Family Perceived Involvement in Decision-Making. J Patient Exp 2022; 9:23743735221092623. [PMID: 35434292 PMCID: PMC9006367 DOI: 10.1177/23743735221092623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family members often act as surrogate decision makers for patients in the intensive care unit (ICU). The use of printed prompts may assist with families feeling empowered to fulfill this role. Prospective, randomized controlled trial in 3 ICUs in Western Australia. In the intervention arm, families received the Choosing Wisely 5 questions as printed prompts prior to a family meeting, and the control arm did not receive prompts. The primary outcome was family perceived involvement in decision-making. Outcomes were measured using a survey. Sixty families participated in the study. The majority of families (87.1% control, 79.3% intervention; P = .334) reported feeling “very included” in decision-making. There was no difference in secondary outcomes, including minimal uptake of the questions by the intervention arm. This has been the first randomized trial evaluating the use of a decision-making tool for families in the ICU. Despite ceiling effects in outcome measures, these results suggest room for future study of the Choosing Wisely 5 questions in the ICU.
Collapse
Affiliation(s)
- Ashleigh Drury
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
| | - Bradley Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
11
|
Keen A, George A, Stuck BT, Snyder C, Fleck K, Azar J, Kara A. Nurse perceptions of a nurse family liaison implemented during the COVID-19 pandemic: A qualitative thematic analysis. Intensive Crit Care Nurs 2021; 70:103185. [PMID: 34996677 PMCID: PMC8639475 DOI: 10.1016/j.iccn.2021.103185] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 12/13/2022]
Abstract
Objective Stress among family members of hospitalised intensive care unit patients may be amplified in the context of a global pandemic and strict visitor restrictions. A nurse family liaison role in the COVID-19 units was implemented to serve as a connection between the care team and a designated family member. Our objective was to describe the experience of a nurse family liaison role implemented during the COVID-19 pandemic from the perspective of nurses who functioned in the liaison role and intensive care nurses who worked with the liaisons. Research method/design This was a qualitative study using thematic analysis involving a one-time semi-structured interview. A convenience sample of nurses were invited to participate. The analytic approach involved (1) becoming familiar with the data; (2) finding meaning in the data; (3) organising meaningful statements into patterns to generate themes. Setting/participants Nurses who functioned in the liaison role and intensive care nurses who worked with the liaisons in an adult academic health center in the Midwest United States. Main outcome measure To describe the psychosocial experience of nurse family liaison role implementation. Findings The sample (n = 11) mean age was 36 years (range 26–49) and the majority were female (n = 10; 90%), White/non-Hispanic (n = 11; 100%), Bachelor prepared (n = 10; 90%), and had an average of 10 years of experience as a nurse (range 4–25). The major themes identified by participants were living in a pandemic, establishing the role and workflow and experiencing human connection. Conclusion Hospital organisations should consider how they can provide family-centred care, specifically within the context of a global crisis such as a pandemic. Participant descriptions of the role indicate that liaison implementation alleviated nurse moral distress and fostered development of close family connections. Findings can help inform implementation of similar roles in hospital settings.
Collapse
Affiliation(s)
- Alyson Keen
- Indiana University Health Adult Academic Health Center, United States.
| | - Annie George
- Indiana University Health Adult Academic Health Center, United States
| | - B T Stuck
- Indiana University Health Adult Academic Health Center, United States
| | - Colby Snyder
- Indiana University Health Adult Academic Health Center, United States
| | - Kyle Fleck
- Indiana University Health Adult Academic Health Center, United States
| | - Jose Azar
- Indiana University Health Adult Academic Health Center, United States; Indiana University School of Medicine, United States
| | - Areeba Kara
- Indiana University Health Adult Academic Health Center, United States; Indiana University School of Medicine, United States
| |
Collapse
|
12
|
Effect of Patient and Family Centred Care interventions for adult intensive care unit patients and their families: A systematic review and meta-analysis. Intensive Crit Care Nurs 2021; 69:103156. [PMID: 34753631 DOI: 10.1016/j.iccn.2021.103156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the evidence for the feasibility and effect of patient and familycentred care interventions provided in the intensive care unit, single or multicomponent, versus usual care, for reducing delirium, anxiety, depression and post-traumatic stress disorder in patients and family-members. DESIGN A systematic review and meta-analysis following the PRISMA guidelines and GRADE approach. A systematic literature search of relevant databases, screening and inclusion of studies, data extraction and assessment of risk of bias according to Cochrane methodology. The study is preregistered on PROSPERO (CRD42020160768). SETTING Adult intensive care units. RESULTS Nine randomised controlled trials enrolling a total of 1170 patients and 1226 family-members were included. We found moderate to low certainty evidence indicating no effect of patient and family centred care on delirium, anxiety, depression, post-traumatic stress disorder, in-hospital mortality, intensive care length of stay or family-members' anxiety, depression and post-traumatic stress disorder. No studies looked at the effect of patient and family centred care on pain or cognitive function in patients. Evaluation of feasibility outcomes was scarce. The certainty of the evidence was low to moderate, mainly due to substantial risk of bias in individual studies and imprecision due to few events and small sample size. CONCLUSION It remains uncertain whether patient and family centred care compared to usual care may reduce delirium in patients and psychological sequelae of intensive care admission in patients and families due to limited evidence of moderate to low certainty. Lack of systematic process evaluation of intervention feasibility as recommended by the Medical Research Council to identify barriers and facilitators of patient and family centred care in the adult intensive care unit context, further limits the conclusions that can be drawn.
Collapse
|
13
|
Aslakson RA, Cox CE, Baggs JG, Curtis JR. Palliative and End-of-Life Care: Prioritizing Compassion Within the ICU and Beyond. Crit Care Med 2021; 49:1626-1637. [PMID: 34325446 DOI: 10.1097/ccm.0000000000005208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Rebecca A Aslakson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
- Division of Primary Care and Population Health, Department of Medicine, Palliative Care Section, Stanford University, Stanford, CA
| | - Christopher E Cox
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Judith G Baggs
- School of Nursing, Oregon Health & Science University, Portland, OR
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| |
Collapse
|
14
|
Anstey MH, Mitchell IA, Corke C, Murray L, Mitchell M, Udy A, Sarode V, Nguyen N, Flower O, Ho KM, Litton E, Wibrow B, Norman R. Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:287. [PMID: 34376239 PMCID: PMC8353726 DOI: 10.1186/s13054-021-03712-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022]
Abstract
Background To test the hypothesis that Intensive Care Unit (ICU) doctors and nurses differ in their personal preferences for treatment from the general population, and whether doctors and nurses make different choices when thinking about themselves, as compared to when they are treating a patient. Methods Cross sectional, observational study conducted in 13 ICUs in Australia in 2017 using a discrete choice experiment survey. Respondents completed a series of choice sets, based on hypothetical situations which varied in the severity or likelihood of: death, cognitive impairment, need for prolonged treatment, need for assistance with care or requiring residential care. Results A total of 980 ICU staff (233 doctors and 747 nurses) participated in the study. ICU staff place the highest value on avoiding ending up in a dependent state. The ICU staff were more likely to choose to discontinue therapy when the prognosis was worse, compared with the general population. There was consensus between ICU staff personal views and the treatment pathway likely to be followed in 69% of the choices considered by nurses and 70% of those faced by doctors. In 27% (1614/5945 responses) of the nurses and 23% of the doctors (435/1870 responses), they felt that aggressive treatment would be continued for the hypothetical patient but they would not want that for themselves. Conclusion The likelihood of returning to independence (or not requiring care assistance) was reported as the most important factor for ICU staff (and the general population) in deciding whether to receive ongoing treatments. Goals of care discussions should focus on this, over likelihood of survival. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03712-4.
Collapse
Affiliation(s)
- Matthew H Anstey
- Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia. .,School of Population Health, Curtin University, Bentley, Australia. .,School of Medicine, University of Western Australia, Crawley, Australia.
| | - Imogen A Mitchell
- Australian National University, Canberra, Australia.,Canberra Hospital, Canberra, Australia
| | | | - Lauren Murray
- Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Marion Mitchell
- Griffith University, Griffith, QLD, Australia.,Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | | | - Vineet Sarode
- Monash University, Melbourne, Australia.,Cabrini Hospital, Melbourne, Australia
| | - Nhi Nguyen
- Nepean Hospital, Kingswood, NSW, Australia
| | | | - Kwok M Ho
- School of Medicine, University of Western Australia, Crawley, Australia.,Royal Perth Hospital, Perth, Australia.,School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Edward Litton
- School of Medicine, University of Western Australia, Crawley, Australia.,Fiona Stanley Hospital, Perth, Australia
| | - Bradley Wibrow
- Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia.,School of Medicine, University of Western Australia, Crawley, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, Australia
| |
Collapse
|
15
|
Piscitello GM, Fukushima CM, Saulitis AK, Tian KT, Hwang J, Gupta S, Sheldon M. Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic. Am J Hosp Palliat Care 2021; 38:305-312. [PMID: 33207937 PMCID: PMC7859662 DOI: 10.1177/1049909120973431] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Visitor restrictions during the COVID-19 pandemic limit in-person family meetings for hospitalized patients. We aimed to evaluate the quantity of family meetings by telephone, video and in-person during the COVID-19 pandemic by manual chart review. Secondary outcomes included rate of change in patient goals of care between video and in-person meetings, the timing of family meetings, and variability in meetings by race and ethnicity. METHODS A retrospective cohort study evaluated patients admitted to the intensive care unit at an urban academic hospital between March and June 2020. Patients lacking decision-making capacity and receiving a referral for a video meeting were included in this study. RESULTS Most patients meeting inclusion criteria (N = 61/481, 13%) had COVID-19 pneumonia (n = 57/61, 93%). A total of 650 documented family meetings occurred. Few occurred in-person (n = 70/650, 11%) or discussed goals of care (n = 233/650, 36%). For meetings discussing goals of care, changes in patient goals of care occurred more often for in-person meetings rather than by video (36% vs. 11%, p = 0.0006). The average time to the first goals of care family meeting was 11.4 days from admission. More documented telephone meetings per admission were observed for White (10.5, SD 9.5) and Black/African-American (7.1, SD 6.6) patients compared to Hispanic or Latino patients (4.9, SD 4.9) (p = 0.02). CONCLUSIONS During this period of strict visitor restrictions, few family meetings occurred in-person. Statistically significant fewer changes in patient goals of care occurred following video meetings compared to in-person meetings, providing support limiting in-person meetings may affect patient care.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Mark Sheldon
- Department of Philosophy, Northwestern University, Evanston, IL, USA
| |
Collapse
|
16
|
Jeitziner MM, Camenisch SA, Jenni-Moser B, Schefold JC, Zante B. End-of-life care during the COVID-19 pandemic-What makes the difference? Nurs Crit Care 2021; 26:212-214. [PMID: 33590618 PMCID: PMC8013875 DOI: 10.1111/nicc.12593] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine A Camenisch
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Béatrice Jenni-Moser
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
17
|
Dionne-Odom JN, Ejem D, Wells R, Barnato AE, Taylor RA, Rocque GB, Turkman YE, Kenny M, Ivankova NV, Bakitas MA, Martin MY. How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study. PLoS One 2019; 14:e0212967. [PMID: 30865681 PMCID: PMC6415885 DOI: 10.1371/journal.pone.0212967] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Abstract
Aims Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver’s role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. Methods Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. Findings Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient’s partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient’s treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing “what if” scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. Conclusions These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.
Collapse
Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amber E. Barnato
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gabrielle B. Rocque
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yasemin E. Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nataliya V. Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| |
Collapse
|