Csilla Kalocsai1,2, Amanda Roze des Ordons3, Tasnim Sinuff4, Ellen Koo5, Orla Smith6, Deborah Cook7, Eyal Golan4, Sarah Hales8, George Tomlinson5,9, Derek Strachan5, Christopher J MacKinnon10, James Downar11. 1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. csilla.kalocsai@camh.ca. 2. Centre for Addiction and Mental Health, CAMH Education, 33 Russell Street, Rm. 2054, Toronto, ON, M5S 2S1, Canada. csilla.kalocsai@camh.ca. 3. Division of Palliative Medicine, Department of Critical Care Medicine, Department of Oncology, Department of Anesthesiology, University of Calgary, Calgary, AB, Canada. 4. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 5. University Health Network, Toronto, ON, Canada. 6. St. Michael's Hospital, Toronto, ON, Canada. 7. Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 8. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 9. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 10. Department of Oncology, McGill University, Montreal, QC, Canada. 11. Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada.
Abstract
PURPOSE: When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS: Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS: Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS: Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.
PURPOSE: When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS: Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS: Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS: Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.
Authors: Nathalie Embriaco; Sami Hraiech; Elie Azoulay; Karine Baumstarck-Barrau; Jean-Marie Forel; Nancy Kentish-Barnes; Frédéric Pochard; Anderson Loundou; Antoine Roch; Laurent Papazian Journal: Ann Intensive Care Date: 2012-07-27 Impact factor: 6.925
Authors: Csilla Kalocsai; Andre Amaral; Dominique Piquette; Grace Walter; Shelly P Dev; Paul Taylor; James Downar; Lesley Gotlib Conn Journal: BMC Health Serv Res Date: 2018-07-09 Impact factor: 2.655