Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia; The Centre for Palliative Care, St Vincent's Hospital Melbourne, 172 Victoria Parade, East Melbourne, Victoria 3002, Australia; Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: https://twitter.com/@AlysiaCoventry.
Department of Nursing, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria 3010, Australia. Electronic address: https://twitter.com/@MarieGerdtz.
Intensive Crit Care Nurs. 2023 Oct;78:103454. doi: 10.1016/j.iccn.2023.103454. Epub 2023 May 28.
Families who perceive themselves as prepared for an impending death experience reduced psychological burden during bereavement. Understanding which interventions promote death preparedness in families during end-of-life care in intensive care will inform future intervention development and may help limit the burden of psychological symptoms associated with bereavement.
To identify and characterise interventions that help prepare families for the possibility of death in intensive care, incorporating barriers to intervention implementation, outcome variables and instruments used.
Scoping review using Joanna Briggs methodology, prospectively registered and reported using relevant guidelines.
A systematic search of six databases from 2007 to 2023 for randomised controlled trials evaluating interventions that prepared families of intensive care patients for the possibility of death. Citations were screened against the inclusion criteria and extracted by two reviewers independently.
Seven trials met eligibility criteria. Interventions were classified: decision support, psychoeducation, information provision. Psychoeducation involving physician-led family conference, emotional support and written information reduced symptoms of anxiety, depression, prolonged grief, and post-traumatic stress in families during bereavement. Anxiety, depression, and post-traumatic stress were assessed most frequently. Barriers and facilitators to intervention implementation were seldom reported.
This review provides a conceptual framework of interventions to prepare families for death in intensive care, while highlighting a gap in rigorously conducted empirical research in this area. Future research should focus on theoretically informed, family-clinician communication, and explore the benefits of integrating existing multidisciplinary palliative care guidelines to deliver family conference within intensive care.
Intensive care clinicians should consider innovative communication strategies to build family-clinician connectedness in remote pandemic conditions. To prepare families for an impending death, mnemonic guided physician-led family conference and printed information could be implemented to prepare families for death, dying and bereavement. Mnemonic guided emotional support during dying and family conference after death may also assist families seeking closure.
在临终关怀中，那些认为自己已经为即将到来的死亡做好准备的家庭，在丧亲期间会减轻心理负担。了解哪些干预措施可以促进重症监护家庭的死亡准备，将为未来的干预措施发展提供信息，并可能有助于减轻与丧亲相关的心理症状负担。
确定并描述有助于家庭为重症监护中死亡可能性做好准备的干预措施，纳入干预措施实施的障碍、结果变量和使用的工具。
使用乔安娜·布里格斯方法进行范围综述，前瞻性注册并按照相关指南进行报告。
系统检索了 2007 年至 2023 年的六个数据库，以寻找评估为重症监护患者家属做好死亡准备的干预措施的随机对照试验。根据纳入标准筛选引文，并由两名审查员独立提取。
符合纳入标准的试验有 7 项。干预措施分为：决策支持、心理教育、信息提供。心理教育包括医生主导的家庭会议、情感支持和书面信息，可减轻丧亲期间家庭的焦虑、抑郁、延长的悲伤和创伤后应激症状。焦虑、抑郁和创伤后应激最常被评估。很少报告干预措施实施的障碍和促进因素。
本综述提供了一个为重症监护家庭做好死亡准备的干预措施概念框架，同时突出了该领域严格进行实证研究的差距。未来的研究应侧重于理论指导的、家庭-临床医生的沟通，并探索整合现有的多学科姑息治疗指南的益处，以便在重症监护室内提供家庭会议。
重症监护临床医生应考虑创新的沟通策略，在远程大流行环境下建立家庭-临床医生的联系。为了让家庭为即将到来的死亡做好准备，可以实施以记忆提示为指导的医生主导的家庭会议和印刷信息，为家庭做好死亡、濒死和丧亲的准备。在临终和死后的家庭会议期间提供以记忆提示为指导的情感支持，也可以帮助寻求解脱的家庭。
