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哀伤干预以支持重症监护病房中的非专业照护者:系统综述。

Bereavement interventions to support informal caregivers in the intensive care unit: a systematic review.

机构信息

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.

出版信息

BMC Palliat Care. 2021 May 12;20(1):66. doi: 10.1186/s12904-021-00763-w.

Abstract

BACKGROUND

Informal caregivers of critically ill patients in intensive care unit (ICUs) experience negative psychological sequelae that worsen after death. We synthesized outcomes reported from ICU bereavement interventions intended to improve informal caregivers' ability to cope with grief.

DATA SOURCES

MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020.

STUDY SELECTION

Randomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU.

DATA EXTRACTION

Two reviewers independently extracted data in duplicate. Narrative synthesis was conducted.

DATA SYNTHESIS

Bereavement interventions were categorized according to the UK National Institute for Health and Clinical Excellence three-tiered model of bereavement support according to the level of need: (1) Universal information provided to all those bereaved; (2) Selected or targeted non-specialist support provided to those who are at-risk of developing complex needs; and/or (3) Professional specialist interventions provided to those with a high level of complex needs. Outcome measures were synthesized according to core outcomes established for evaluating bereavement support for adults who have lost other adults to illness.

RESULTS

Three studies of ICU bereavement interventions from 31 ICUs across 26 hospitals were included. One trial examining the effect of family presence at brain death assessment integrated all three categories of support but did not report significant improvement in emotional or psychological distress. Two other trials assessed a condolence letter intervention, which did not decrease grief symptoms and may have increased symptoms of depression and post-traumatic stress disorder, and a storytelling intervention that found no significant improvements in anxiety, depression, post-traumatic stress, or complicated grief. Four of nine core bereavement outcomes were not assessed anytime in follow-up.

CONCLUSIONS

Currently available trial evidence is sparse and does not support the use of bereavement interventions for informal caregivers of critically ill patients who die in the ICU.

摘要

背景

重症监护病房(ICU)中危重病患者的非专业护理人员会经历负面的心理后果,而在患者去世后这种后果会恶化。我们综合了旨在提高非专业护理人员应对悲伤能力的 ICU 丧亲干预措施所报告的结果。

资料来源

从创建到 2020 年 10 月,MEDLINE、EMBASE、CINAHL 和 PsycINFO。

研究选择

支持 ICU 中死亡的成年患者的非专业护理人员的丧亲干预措施的随机对照试验(RCT)。

资料提取

两位审查员独立重复提取数据。进行了叙述性综合。

资料综合

丧亲干预措施根据英国国家卫生与临床优化研究所(NICE)的三级丧亲支持模型进行分类,根据需求水平:(1)向所有丧亲者提供通用信息;(2)向有发展复杂需求风险的人提供有选择或有针对性的非专业支持;和/或(3)向有高复杂需求的人提供专业的专家干预措施。根据为评估因疾病而失去其他成年人的成年人的丧亲支持而制定的核心结果来综合衡量结果。

结果

纳入了来自 26 家医院 31 家 ICU 的三项 ICU 丧亲干预措施研究。一项研究检验了在脑死亡评估时家属在场的效果,综合了所有三种支持类别,但并未报告情绪或心理困扰有显著改善。另外两项试验评估了唁函干预措施,该措施并未减轻悲伤症状,反而可能增加了抑郁和创伤后应激障碍症状,以及一个讲故事的干预措施,该措施未发现焦虑,抑郁,创伤后压力或复杂悲伤有任何显著改善。在随访期间,有四个核心丧亲结果中的九个未进行评估。

结论

目前可用的试验证据很少,不支持对 ICU 中死亡的危重病患者的非专业护理人员使用丧亲干预措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b845/8117265/51ba48d4dca5/12904_2021_763_Fig1_HTML.jpg

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