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

Stephana J Moss,Kirsten M Fiest,Krista Wollny,Therese G Poulin,Amanda Roze Des Ordons,Deborah J Cook,Henry T Stelfox

doi:10.1186/s12904-021-00763-w

Abstract

BackgroundInformal 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 sourcesMEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2020.Study selectionRandomized controlled trials (RCTs) of bereavement interventions to support informal caregivers of adult patients who died in ICU.Data extractionTwo reviewers independently extracted data in duplicate. Narrative synthesis was conducted.Data synthesisBereavement 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.ResultsThree 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.ConclusionsCurrently 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.

Highlights

Informal caregivers of critically ill patients in the intensive care unit (ICU) experience negative psychological and emotional sequelae [1, 2] that worsen after patient death [3, 4]
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
The core outcomes set developed for adult palliative care settings [13] is relevant for use in ICU given that death in ICU is common and that bereavement interventions to prepare informal caregivers to cope with their grief may be appropriate across the entire critical illness trajectory [14]

Summary

Introduction

Informal caregivers (i.e., family, friends) of critically ill patients in the intensive care unit (ICU) experience negative psychological and emotional sequelae [1, 2] that worsen after patient death [3, 4]. A 2019 narrative review reported inconsistent evidence for the association between bereavement support in adult ICU and informal caregiver outcomes, noting methodological shortcomings in the evidence [12]. Since 2019, a set of core outcomes was developed to address inconsistent evaluation of bereavement services and models of support for informal caregivers in adult palliative care [13]. The core outcomes set developed for adult palliative care settings [13] is relevant for use in ICU given that death in ICU is common and that bereavement interventions to prepare informal caregivers to cope with their grief may be appropriate across the entire critical illness trajectory [14].

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