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Dennis B, Vanstone M, Swinton M, Brandt Vegas D, Dionne JC, Cheung A, Clarke FJ, Hoad N, Boyle A, Huynh J, Toledo F, Soth M, Neville TH, Fiest K, Cook DJ. Sacrifice and solidarity: a qualitative study of family experiences of death and bereavement in critical care settings during the pandemic. BMJ Open 2022; 12:e058768. [PMID: 35046010 PMCID: PMC8771806 DOI: 10.1136/bmjopen-2021-058768] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pandemic-related restrictions are expected to continue to shape end-of-life care and impact the experiences of dying hospitalised patients and their families. OBJECTIVE To understand families' experiences of loss and bereavement during and after the death of their loved one amidst the SARS-CoV-2 (COVID-19) pandemic. DESIGN Qualitative descriptive study. SETTING Three acute care units in a Canadian tertiary care hospital. PARTICIPANTS Family members of 28 hospitalised patients who died from March-July 2020. MAIN OUTCOME MEASURES Qualitative semistructured interviews conducted 6-16 months after patient death inquired about family experiences before and beyond the death of their loved one and garnered suggestions to improve end-of-life care. RESULTS Pandemic restrictions had consequences for families of dying hospitalised patients. Most family members described an attitude of acquiescence, some framing their experience as a sacrifice made for the public good. Families appreciated how clinicians engendered trust in the name of social solidarity while trying to mitigate the negative impact of family separation. However, fears about the patient's experience of isolation and changes to postmortem rituals also created despair and contributed to long-lasting grief. CONCLUSION Profound loss and enduring grief were described by family members whose final connections to their loved one were constrained by pandemic circumstances. Families observed solidarity among clinical staff and experienced a sense of unity with staff, which alleviated some distress. Their suggestions to improve end-of-life care given pandemic restrictions included frequent, flexible communication, exceptions for family presence when safe, and targeted efforts to connect patients whose isolation is intensified by functional impairment or limited technological access. TRIAL REGISTRATION NUMBER NCT04602520; Results.
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Affiliation(s)
- Brittany Dennis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Joanna C Dionne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Cheung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - France J Clarke
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Neala Hoad
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Anne Boyle
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Huynh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Feli Toledo
- Department of Spiritual Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mark Soth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Thanh H Neville
- University of California Los Angeles, Los Angeles, California, USA
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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