Schenker Yael, Dew Mary Amanda, Reynolds Charles F, Arnold Robert M, Tiver Greer A, Barnato Amber E
Division of General Internal Medicine,Department of Medicine,University of Pittsburgh,Pittsburgh,Pennsylvania.
Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania.
Palliat Support Care. 2015 Jun;13(3):451-63. doi: 10.1017/S1478951513001211. Epub 2014 Feb 13.
Surrogates involved in decisions to limit life-sustaining treatment for a loved one in the intensive care unit (ICU) are at increased risk for adverse psychological outcomes that can last for months to years after the ICU experience. Post-ICU interventions to reduce surrogate distress have not yet been developed. We sought to (1) describe a conceptual framework underlying the beneficial mental health effects of storytelling, and (2) present formative work developing a storytelling intervention to reduce distress for recently bereaved surrogates.
An interdisciplinary team conceived the idea for a storytelling intervention based on evidence from narrative theory that storytelling reduces distress from traumatic events through emotional disclosure, cognitive processing, and social connection. We developed an initial storytelling guide based on this theory and the clinical perspectives of team members. We then conducted a case series with recently bereaved surrogates to iteratively test and modify the guide.
The storytelling guide covered three key domains of the surrogate's experience of the patient's illness and death: antecedents, ICU experience, and aftermath. The facilitator focused on the parts of a story that appeared to generate strong emotions and used nonjudgmental statements to attend to these emotions. Between September 2012 and May 2013, we identified 28 eligible surrogates from a medical ICU and consented 20 for medical record review and recontact; 10 became eligible, of whom 6 consented and completed the storytelling intervention. The single-session storytelling intervention lasted from 40 to 92 minutes. All storytelling participants endorsed the intervention as acceptable, and five of six reported it as helpful.
Surrogate storytelling is an innovative and acceptable post-ICU intervention for recently bereaved surrogates and should be evaluated further.
在重症监护病房（ICU）中，参与为亲人做出限制维持生命治疗决策的替代决策者出现不良心理后果的风险增加，这些后果可能在ICU经历后的数月至数年持续存在。尚未开发出降低替代决策者痛苦的ICU后干预措施。我们试图：（1）描述故事讲述对心理健康有益影响的概念框架；（2）介绍为减少近期丧亲替代决策者的痛苦而开展的故事讲述干预措施的形成性研究工作。
一个跨学科团队基于叙事理论的证据构思了故事讲述干预措施，该理论认为故事讲述通过情感披露、认知处理和社会联系减轻创伤事件带来的痛苦。我们基于该理论和团队成员的临床观点制定了初步的故事讲述指南。然后，我们对近期丧亲的替代决策者进行了一系列案例研究，以反复测试和修改该指南。
故事讲述指南涵盖了替代决策者对患者疾病和死亡经历的三个关键领域：前因、ICU经历和后果。引导者关注故事中似乎引发强烈情感的部分，并使用无评判性的陈述来关注这些情感。在2012年9月至2013年5月期间，我们从一个医疗ICU中识别出28名符合条件的替代决策者，并征得20人的同意进行病历审查和再次联系；其中10人符合条件，6人同意并完成了故事讲述干预。单次故事讲述干预持续40至92分钟。所有参与故事讲述的人都认可该干预措施是可接受的，六人中五人表示该有帮助了帮助。
替代决策者故事讲述是一种创新且可接受的针对近期丧亲替代决策者的ICU后干预措施，应进一步评估。
