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Labram AH, Johnston B, McGuire M. An integrative literature review examining the key elements of bereavement follow-up interventions in critical care. Curr Opin Support Palliat Care 2023; 17:193-207. [PMID: 37432078 PMCID: PMC10371062 DOI: 10.1097/spc.0000000000000666] [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] [Indexed: 07/12/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to examine bereavement follow-up intervention studies in critical care, with the purpose of integrating results on the timing, content, aims and outcomes of interventions. The impact of a death in critical care is well documented, and bereavement follow-up is recognised as an important topic, but there is limited research with little consensus on the content and structure of interventions. RECENT FINDINGS A total of 18 papers were selected; 11 are intervention studies, with only one randomised control trial. Six papers were from national surveys and are not the focus of this review. Bereavement follow-up mainly consisted of information giving, condolence interventions, telephone calls and meetings with families. The timing, content, aims and outcomes depended on the intervention and were influenced by the design of the study. SUMMARY Overall, bereavement follow-up is acceptable for relatives but outcomes are mixed. Calls for more research are valid, but how do we utilise the current research to better inform the critical care community? Researchers suggest that bereavement follow-up interventions need to be designed with specific aims and outcomes, in collaboration with bereaved families that are appropriate to the intervention.
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Warner BE, Harry A, Wells M, Brett SJ, Antcliffe DB. Escalation to intensive care for the older patient. An exploratory qualitative study of patients aged 65 years and older and their next of kin during the COVID-19 pandemic: the ESCALATE study. Age Ageing 2023; 52:7127657. [PMID: 37083851 PMCID: PMC10120351 DOI: 10.1093/ageing/afad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND older people comprise the majority of hospital medical inpatients so decision-making regarding admission of this cohort to the intensive care unit (ICU) is important. ICU can be perceived by clinicians as overly burdensome for patients and loved ones, and long-term impact on quality of life considered unacceptable, effecting potential bias against admitting older people to ICU. The COVID-19 pandemic highlighted the challenge of selecting those who could most benefit from ICU. OBJECTIVE this qualitative study aimed to explore the views and recollections of escalation to ICU from older patients (aged ≥ 65 years) and next of kin (NoK) who experienced a COVID-19 ICU admission. SETTING the main site was a large NHS Trust in London, which experienced a high burden of COVID-19 cases. SUBJECTS 30 participants, comprising 12 patients, 7 NoK of survivor and 11 NoK of deceased. METHODS semi-structured interviews with thematic analysis using a framework approach. RESULTS there were five major themes: inevitability, disconnect, acceptance, implications for future decision-making and unique impact of the COVID-19 pandemic. Life was highly valued and ICU perceived to be the only option. Prior understanding of ICU and admission decision-making explanations were limited. Despite benefit of hindsight, having experienced an ICU admission and its consequences, most could not conceptualise thresholds for future acceptable treatment outcomes. CONCLUSIONS in this study of patients ≥65 years and their NoK experiencing an acute ICU admission, survival was prioritised. Despite the ordeal of an ICU stay and its aftermath, the decision to admit and sequelae were considered acceptable.
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Affiliation(s)
- Bronwen E Warner
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Critical Care Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Alice Harry
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Anaesthetics, Royal Free London NHS Foundation Trust, London, UK
| | - Mary Wells
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen J Brett
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Critical Care Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - David B Antcliffe
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Critical Care Medicine, Imperial College Healthcare NHS Trust, London, UK
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Intensive Care Unit Nurse: Could We Call a Palliative Care Consult? Intensive Care Unit Provider: It's Too Early. Palliative Care Integration in the Intensive Care Unit: The Struggle to Translate Evidence Into Practice. Dimens Crit Care Nurs 2021; 40:51-58. [PMID: 33560635 DOI: 10.1097/dcc.0000000000000451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations for a collaborative palliative care practice framework that holds the potential to improve quality of life for patients and families. Collaborative palliative care is characterized by close working relationships with families, interprofessional intensive care unit healthcare teams, and palliative care specialists. The shortage of palliative care specialists has become a pressing policy and practice issue and highlights the importance of increasing primary palliative care delivery by the intensive care team. Underexplored aspects of collaborative palliative care delivery include the interprofessional communication required, identification of key skills, and expected outcomes. Increased recognition of intensive care unit palliative care as a process of engagement among nurses, providers, patients, and their family members heralds a vital culture shift toward collaborative palliative care. The interprofessional palliative specialist team has the expertise to support intensive care teams in developing their primary palliative skills and recognizing when specialist palliative care support is required. Promotion of strategic palliative care delivery through this collaborative framework has the potential to decrease suffering among patients and families and reduce moral distress among healthcare professionals.
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Takaoka A, Vanstone M, Neville TH, Goksoyr S, Swinton M, Clarke FJ, Smith OM, LeBlanc A, Foster D, Kao Y, Xu X, Hoad N, Toledo F, Cook DJ. Family and Clinician Experiences of Sympathy Cards in the 3 Wishes Project. Am J Crit Care 2020; 29:422-428. [PMID: 33130860 DOI: 10.4037/ajcc2020733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A recent randomized trial of bereaved family members of patients who died in an intensive care unit identified symptoms of depression and posttraumatic stress in recipients of semistructured condolence letters. OBJECTIVES To explore family member and clinician experiences with receiving or sending handwritten sympathy cards upon the death of patients involved in a personalized end-of-life intervention, the 3 Wishes Project. METHODS Interviews and focus groups were held with 171 family members and 222 clinicians at 4 centers to discuss their experiences with the 3 Wishes Project. Interview transcripts were searched to identify participants who discussed sympathy cards. Data related to sympathy cards were independently coded by 2 investigators through conventional content analysis. RESULTS Sympathy cards were discussed during 32 interviews (by 25 family members of 21 patients and by 11 clinicians) and 2 focus groups (8 other clinicians). Family members reported that personalized sympathy cards were a welcome surprise; they experienced them as a heartfelt act of compassion. Clinicians viewed cards as an opportunity to express shared humanity with families, reminding them that they and their loved one were not forgotten. Signing cards allowed clinicians to reminisce individually and collectively with colleagues. Family members and clinicians experienced sympathy cards as a meaningful continuation of care after a patient's death. CONCLUSIONS Inviting clinicians who cared for deceased patients to offer personalized, handwritten condolences to bereaved family members may cultivate sincere and individualized expressions of sympathy that bereaved families appreciate after the death of patients involved in the 3 Wishes Project.
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Affiliation(s)
- Alyson Takaoka
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Thanh H. Neville
- Thanh H. Neville is an assistant professor and critical care physician, Department of Medicine, Division of Pulmonary and Critical Care, and Yuhan Kao is a clinical nurse specialist and Xueqing Xu is a nursing unit director, Department of Nursing, University of California Los Angeles, Los Angeles, California
| | - Sophia Goksoyr
- Sophia Goksoyr is a registered social worker, Allana LeBlanc is a clinical nurse specialist, and Denise Foster is a registered nurse and research coordinator, Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Marilyn Swinton
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - France J. Clarke
- Takaoka was a graduate student at the time the work was conducted, Marilyn Swinton is a research coordinator, and France J. Clarke is a respiratory therapist and research coordinator, Department of Health Research Methods, Evidence, and Impact, Meredith Vanstone is an associate professor, Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Orla M. Smith
- Orla M. Smith is a registered nurse and associate scientist, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Allana LeBlanc
- Sophia Goksoyr is a registered social worker, Allana LeBlanc is a clinical nurse specialist, and Denise Foster is a registered nurse and research coordinator, Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Denise Foster
- Sophia Goksoyr is a registered social worker, Allana LeBlanc is a clinical nurse specialist, and Denise Foster is a registered nurse and research coordinator, Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Yuhan Kao
- Thanh H. Neville is an assistant professor and critical care physician, Department of Medicine, Division of Pulmonary and Critical Care, and Yuhan Kao is a clinical nurse specialist and Xueqing Xu is a nursing unit director, Department of Nursing, University of California Los Angeles, Los Angeles, California
| | - Xueqing Xu
- Thanh H. Neville is an assistant professor and critical care physician, Department of Medicine, Division of Pulmonary and Critical Care, and Yuhan Kao is a clinical nurse specialist and Xueqing Xu is a nursing unit director, Department of Nursing, University of California Los Angeles, Los Angeles, California
| | - Neala Hoad
- Neala Hoad is a registered nurse and research coordinator, Department of Critical Care, and Feli Toledo is a chaplain and registered psychotherapist, Department of Spiritual Care, St Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Feli Toledo
- Neala Hoad is a registered nurse and research coordinator, Department of Critical Care, and Feli Toledo is a chaplain and registered psychotherapist, Department of Spiritual Care, St Joseph’s Healthcare Hamilton, Ontario, Canada
| | - Deborah J. Cook
- Deborah J. Cook is a critical care physician, Department of Critical Care, St Joseph’s Healthcare Hamilton, and a distinguished professor in the Departments of Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University
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Bove DG, Rosted E, Prip A, Jellington MO, Timm H, Herling SF. How to care for the brought in dead and their relatives. A qualitative study protocol based on interpretive description. J Adv Nurs 2020; 76:1794-1802. [PMID: 32180240 DOI: 10.1111/jan.14353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 01/10/2023]
Abstract
AIM This project has two aims: (a) What do relatives to brought in dead (BID) describe as helpful and supportive care when they arrive at the emergency department to see and say goodbye to a deceased? (b) What do nurses describe as good nursing practice for BID persons and their relatives and what may hinder or facilitate this practice in an emergency setting? DESIGN A qualitative study in the methodology interpretive description. METHODS Data will be collected through three data sources: Individual interviews with relatives to BID persons, participant observations of relatives to BID persons during their presence in the emergency department and focus group interviews with emergency nurses. DISCUSSION Brought in dead persons and their relatives are received and cared for in emergency departments by emergency nurses. Knowledge of how to render care for the relatives to BID persons in an acute setting including what skills and competences this require of the nurses is warranted. We need to explore, describe, and comprehend the experiences of both the relatives and the nurses to point out potential areas of improvement. IMPACT This study is a protocol of an Interpretive Description study offering insight into considerations and reflections in designing the study.
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Affiliation(s)
- Dorthe Gaby Bove
- Emergency Department, Copenhagen University Hospital, Nordsjaelland, Hillerød, Denmark
| | - Elizabeth Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
| | - Anne Prip
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen N, Denmark
| | - Maria Omel Jellington
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjaelland, Denmark
| | - Helle Timm
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | - Suzanne Forsyth Herling
- The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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