A Systematic Review of Family Witnessed Resuscitation and Family Witnessed Invasive Procedures in Adults in Hospital Settings Internationally - Part II: Perspectives of Healthcare Providers.

Abstract

Medicalization of care has removed family members from loved ones during critical events. Family Witnessed Resuscitation and Family Witnessed Invasive Procedures represent patient / family centered care options that can assist with having the family at the bedside during this perilous time. The objective was to examine the evidence on FWR and FWIP in adults from the perspective of healthcare providers. This review considered studies involving healthcare providers overseeing the medical care of adult patients in intensive care units, emergency departments, trauma rooms and general nursing wards.This review examined interventions used for the adoption/implementation of FWR and FWIP including but not limited to: formal policy and guidelines; family facilitator/chaperone role; educational programming; communication approaches; and debriefing.This review considered studies that included the following outcome measures for healthcare providers: actual or perceived responses to FWR and FWIP, and factors affecting the adoption/implementation of FWR and FWIP.Randomised controlled trials, controlled trials, cohort studies, case-control studies, before and after studies, case series studies, and survey studies were considered for inclusion. A comprehensive multistep search was undertaken for English language published and unpublished studies from 1985-2010. Retrieved papers were assessed for methodological quality independently by two reviewers, using appropriate JBI critical appraisal tools. Findings were extracted using researcher-developed de novo tools, utilizing a framework of experiential, participant, and environmental factors influencing FWR/FWIP. Meta-analysis was possible for 5 studies; all other results of this review are presented in narrative form. 38 studies were retrieved and after critical appraisal a total of 28 studies were included for the perspectives of healthcare providers. There was one randomized controlled trial and one match-controlled study, representing JBI Level II and IIIa evidence, respectively. All other healthcare provider studies were descriptive cross-sectional survey designs representing JBI Level IIIc evidence. There exists mixed support for family witnessed resuscitation among healthcare providers in the included studies. Factors such as duration of clinical practice in nursing or critical care, the study setting and the presence of a formal institutional policy all appear to play an important role in the perspectives of healthcare providers on family witnessed resuscitation. Health care organisations should consider the fact that healthcare providers overall do not object to family witnessed resuscitation on the basis of its outcomes, but rather on the processes of its implementation and the decision-making that is required. There is insufficient evidence on family witnessed invasive procedures to make policy recommendations. There is a need for well-designed randomised controlled designs that test the effectiveness of different approaches to FWR with outcomes that go beyond the level of support for the procedure. NOTE:: This is Part II of the systematic review report. Part II of the review report will explicate the perceptions of healthcare providers on family witnessed resuscitation (FWR) and family witnessed invasive procedures (FWIP) in the adult population in emergency departments, intensive care units and general hospital wards internationally. Part I of the review report will explicate the perceptions of patients and their relatives regarding this phenomenon.Both review reports (part I and part II) are based on the same a priori approved review protocol. The decision to provide two review reports for one review protocol was justified for the sake of improved organization of the results. The volume of information from part I and part II, if combined, would make the review excessively long and difficult to read. Furthermore, some studies analysed the perspectives of both patients/families and healthcare providers. Thus, to minimize the risk of study selection bias, the reviewers decided that a separate round of critical appraisal and data extraction of studies was prudent in order to fully and independently explicate the perspectives of patients/families and healthcare providers.Furthermore, the textual component initially proposed in the approved review protocol was not included namely because the majority of FWR and FWIP protocols from the included studies could not be located for further analysis. Also, the reviewers determined that a separate systematic review that searches specifically for studies rich in textual information would be needed to truly capture the breadth of expert opinions and consensus statements on the issues of FWR and FWIP.