Elsevier

Journal of Critical Care

Volume 29, Issue 2, April 2014, Pages 311.e9-311.e16
Journal of Critical Care

Electronic Article
The desirability of an Intensive Care Unit (ICU) Clinician-Led Bereavement Screening and Support Program for Family Members of ICU Decedents (ICU Bereave)

https://doi.org/10.1016/j.jcrc.2013.11.024Get rights and content

Abstract

Purpose

Many bereaved family members (FMs) of intensive care unit decedents experience symptoms of complicated grief (CG) or social distress, but there is no standard screening or follow-up for these individuals. We determined the desirability and need for an intensive care unit–based bereavement screening and support program for these FMs.

Methods

We surveyed bereaved FMs to measure symptoms of CG, prolonged grief disorder, and social difficulties and the desire for support; and staff physicians and nurses at 2 teaching hospitals in Toronto, Canada, to determine comfort and interest in providing routine bereavement support.

Results

We could not contact 69% of FMs largely because of inaccuracies in the patient record. Of the 64 who were contacted, 32 (50%) agreed to be surveyed a mean (SD) of 7.4 (2.2) months after the loss of their relative. Among eligible staff, 57 (61%) of 94 completed the questionnaire. Nine (28%) FMs met subthreshold criteria for CG or prolonged grief disorder, and 7 (22%) met criteria for social distress. Only 10 (31%) had received professional support for emotional symptoms, and 2 (6%) received professional assistance for their social difficulties. Fifty-eight percent supported routine screening, and 68% wanted to receive (or receive more) support. Fifty-five percent of FMs expressed a strong willingness to meet with the medical team to review events surrounding the death of the patient, which was the type of support that the health care staff were most comfortable providing. Most staff (85%) reported providing emotional support at the time of death, but few provided any support afterwards. Fifty-six (98%) of 57 would be willing to support or participate in a formal bereavement screening and support program. Respondents cited the need for training and dedicated time to carry out such a program.

Conclusions

An ICU-based bereavement screening and support program for FMs of ICU decedents is both needed and desirable, although there are important needs and barriers. Future studies should evaluate the effectiveness for such a program at improving outcomes among bereaved FMs.

Introduction

Almost 240,000 Canadians died in 2009 [1], representing 0.7% of the population. When people die, their close family members (FMs) and friends normally experience “grief,” which is an emotional reaction to the loss. In most cases, grief is relatively mild and resolves in less than 6 months without serious social, psychological, or medical consequences. However, severe or prolonged grief may be complicated by a psychiatric or medical disorder that results in declining health, increased use of health care resources, and even death [2], [3]. Prolonged grief disorder (PGD) and complicated grief (CG) are terms applied to severe grief-related disorders that persist beyond 6 months. They are distinct from other psychiatric disorders (Appendix A and Shear et al [4]) and respond to specific forms of cognitive behavioral therapy [4], [5]. Bereaved FMs are also at risk of social distress, which is marked by difficulties with activities of daily living, financial matters, and interactions with other people [6].

Mortality is common in the intensive care unit (ICU). Intensive care unit mortality is associated with a higher incidence of CG reactions, with symptoms of psychiatric illness in 34% to 67% [7], [8] of surviving FMs. However, there is no standard screening or follow-up to identify those at risk. Even when FMs have an identified psychiatric illness or social difficulty, they are often unaware of or unable to access existing services to address these needs.

Many bereaved FMs would like a bereavement support service to be available [9]. Moreover, Critical Care Societies have identified bereavement support as a clinical and research priority [10], [11]. Published palliative care guidelines suggest that bereaved FMs should be contacted in the weeks to months after a death and that each family should have a customized bereavement care plan [12]. Previous authors have suggested that ICU-based health care providers are well positioned to organize a bereavement care plan [3], [13].

An ICU-based bereavement screening and support program would be one potential response to calls for improved bereavement support. This program could screen bereaved FMs for symptoms of severe grief, social distress, or informational needs, and provide support or refer them for appropriate follow-up based on their needs. As preliminary work to develop such a program at our institution, we conducted surveys to determine whether an ICU-based bereavement screening and support program would be necessary and desirable from the perspective of FMs and clinicians, and whether ICU-based clinicians would want to participate in such a program.

Section snippets

Methods

We wanted to understand the information needs and the burden of CG and social distress among FMs of ICU decedents and the proportion who would accept support for these problems. We also sought to determine whether ICU clinicians are currently involved in bereavement support and if they are interested in participating in a formal follow-up and support program for bereaved FMs.

We conducted both a telephone-administered survey of bereaved FMs and a self-administered survey of staff physicians and

Bereaved FMs

We present eligibility and enrolment data in Fig. 1. We were unable to contact 148 (69%) “emergency contacts” because of incomplete or inaccurate contact information, or loss of contact after initial contact. In total, 32 FMs participated (1 terminated the interview early but did not want to withdraw from the study), representing 15% of decedents but 50% of those who were contacted and met inclusion criteria.

Table 1 shows demographic information for the FMs and relevant clinical information

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Acknowledgments

We are grateful to the generosity of the FMs who participated in this study at a very difficult time and the ICU clinicians who responded to the questionnaires. This study was funded by the Toronto General Hospital Foundation.

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    Conflicts of interest: none to declare.

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