Abstract
BackgroundWhen a patient is approaching death in the intensive care unit (ICU), patients’ relatives must make a rapid transition from focusing on their beloved one’s recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is to develop and implement a multicomponent bereavement support intervention for relatives of deceased ICU patients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression and posttraumatic stress in bereaved relatives.MethodsThe study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in the Netherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in 2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities and evidence-based practices, a nurse-led intervention will be developed and implemented during the study period. This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, will serve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200 relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety, depression and posttraumatic stress. Differences between the baseline and follow-up measurements will be calculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, risk profiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted.DiscussionThe newly developed intervention has the potential to improve the bereavement process of the relatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression, anxiety and posttraumatic stress, might decrease.Trial registrationNetherlands Trial Register Registered on 27/07/2019 as NL 7875, www.trialregister.nl
Highlights
When a patient is approaching death in the intensive care unit (ICU), patients’ relatives must make a rapid transition from focusing on their beloved one’s recovery to preparation for their unavoidable death
When a patient is approaching death in the ICU, relatives need to make a rapid transition from focusing on the recovery of their beloved one to preparing for their unavoidable death
A French multicenter study among the relatives of 475 deceased ICU patients reported an incidence of complicated grief assessed by the Inventory of Complicated Grief (ICG) in half of the respondents at 6 months (52%), which remained unchanged at 12 months [19]
Summary
When a patient is approaching death in the intensive care unit (ICU), patients’ relatives must make a rapid transition from focusing on their beloved one’s recovery to preparation for their unavoidable death. A patient’s death in an ICU can have a strikingly guided character and is difficult to compare with the dying situations in other healthcare settings or at home [8]. Palliative care in this phase aims to improve the quality of dying and death with personalized attention to physical, social, psychological and spiritual dimensions of care and well-being [2, 9], using variable methods and care plans [10]. A gap exists in adequate ICU-based studies evaluating family-centered experiences and long-term health outcomes of bereavement care other than ‘satisfaction’ after the death of an ICU patient [9]
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