The Lived Experience of Respiratory Therapists During Withdrawal of Advanced Life-Sustaining Therapies at End of Life in the ICU

Health Care Professionals' Views and Practices Regarding Bereavement Support

BACKGROUND

Because the death of a loved one is distressing for families, bereavement support is recommended for high-quality end-of-life care. Although health care professionals provide support during the death, many do not routinely follow up with bereaved families.

OBJECTIVES

To describe and compare how health care professionals view and provide bereavement support.

METHODS

This prospective, cross-sectional study assessed registered nurses, physicians, social workers, respiratory therapists, and unlicensed assistive personnel working in the intensive care unit, step-down unit, and emergency department. Health care professionals completed a survey assessing their views, practices, and training in providing bereavement support to families. Descriptive statistics and the Kruskal-Wallis test were used to describe and compare the groups.

RESULTS

Among 123 health care professionals, 67.5% were registered nurses and 78% were female. Most (64.2%) supported families at the time of death; however, only 6.5% followed up with bereaved families in the weeks after the death. Physicians, social workers, and registered nurses provided bereavement support more often than unlicensed assistive personnel and respiratory therapists did (P = .001). Only 29.3% were very comfortable providing support to bereaved families. Respiratory therapists were less comfortable than other health care professionals (P = .002). Most health care professionals (54.5%) wanted formal training on providing bereavement support. The main barriers to providing bereavement support included lack of training, time, and resources.

CONCLUSIONS

Understanding health care professionals' views and practices on providing bereavement support may help inform the development of appropriate educational materials, interventions, and protocols around bereavement support.

An Approach to Caring for Patients and Family of Patients Dying in the ICU

TOPIC IMPORTANCE

Death is common in the ICU and often occurs after a decision to withhold or withdraw life-sustaining therapies. Care of the dying is a core skill for ICU clinicians, requiring expert communication, primarily with family of critically ill patients.

REVIEW FINDINGS

Limited high-quality evidence supports specific practices related to the care of dying patients in the ICU; thus, many of the recommendations that exist are based on expert opinion. Value exists in sharing a practical approach to caring for patients during the dying process, including topics to be addressed with family members, rationales for recommended care, and strategies for implementing comfort measures only. Through dedicated preparation and planning, clinicians can help family members navigate this intense experience.

SUMMARY

After a decision had been made to discontinue life-sustaining therapies, family members need to be given a clear description of comfort measures only and provided with additional detail about what it entails, including therapies or interventions to be discontinued, monitoring during the dying process, and common features of the dying process. Order sets can be a valuable resource for ensuring that adequate analgesia and sedation are available and the care plan is enacted properly. To achieve a good death for patients, a collaborative effort among members of the care team is essential.