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EP.062
A Pilot Study on Feasibility of Intensive Care Unit Bereavement Follow-up Service

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INTENSIVE  CARE  UNIT  BEREAVEMENT  FOLLOW-UP

 

 Introduction

  • Death in intensive care units (ICU) is common, frequently unexpected and traumatic. 

  • It can be associated with marked psychopathology among bereaved family members.1 

  • Good end-of-life care around and beyond death is crucial.2,3  One of the strategies to facilitate this is to provide bereavement follow-up (BFU) service.4,5

  • In the Royal Adelaide Hospital, 390 out of 1250 (31%) hospital deaths involved admission to the ICU.

 

Aims

  • Primary aim: to determine the feasibility of providing BFU in the ICU. 

  • Secondary aims:

  1. Collate and evaluate feedback received.

  2. Evaluate families’ responses to BFU.

  3. Ensure organ donation was considered as part of high quality end-of-life care.

     

 Methods

  • Prospective, single-centre, observational study, in a tertiary adult ICU in Australia.

  • Inclusion criteria: all patients who died in the ICU.

  • Referral at consensus for palliative care approach, to a 24-hour referral service.

  • After patient’s death, previously identified family member received bereavement information and details of the 30-minute follow-up telephone interview.

  •  Calls were made at 4 weeks, with questions based on a modified CAESAR Tool to evaluate experience around the end-of-life.6 

  • Responses were recorded as Likert scores, options to provide qualitative feedback.

 

Results

From 1 February 2018 November 2018

Total number of deaths in ICU                                                  : 228

Total number of deaths enrolled in BFU                                      : 155 (68% of total death in ICU)

Total number of deaths missed                                                  : 70 (31% of total ICU deaths)                    

Total number of families who declined enrolment                        : 3 (1% of total ICU deaths)

Total number of families eligible for follow-up calls                      : 147

  • From qualitative feedback

  • Comments associated with high levels of satisfaction:

  • Acknowledgement of person (staff members talking to and about the patients).

  • Regular updates regarding clinical progress.

  • Opportunities for questions and clarification.

  • Opportunity to spend time at bedside.

    Concerns which detracted from end-of-life experience:

 

  • Extended waiting times, absent from patient.

  • Perceived poor communication around severity of illness.

  • Variation in staff skill mix (agency nursing care unfavourable compared to regular ICU nursing staff).

  • 23 respondents (30%) reported that the subject of organ donation was raised

  • Many respondents pointed out that they would be reliant on the organ donor register for their decision making.

 

Conclusion

  • Comprehensive bereavement follow-up after death in ICU is feasible but resource intensive (collaboration between ICU and DonateLife).

    Calls were well received and identified areas for improvement

     

 References

  1. Azoulay E, Pochard F, Kentish-Barnes N, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171: 987-994.
  2. Myburgh J, Abillama F, Chiumello D, et al. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2016; 34: 125-130.
  3. Warrillow S, Moran J, Jones D. Experience and outcomes for relatives of patients dying in the ICU: the CAESAR Tool. J Thorac Dis 2016; 8(7): E611-E614.
  4. Cuthbertson S, Margetts M, Streat S. Bereavement follow-up after critical illness. Crit Care Med 2000; 28(4): 1196-1201.
  5. Milberg a, Olsson E, Jakobsson M, et al. Family members’ perceived needs for bereavement follow-up. J Pain Symptom Manage 2008; 35(1): 58-69.
  6. Kentish-Barnes N, Seegers V, Legriel S, et al. CAESAR: a new tool to assess relatives’ experience of dying and death in the ICU. Intensive Care Med 2016; 42: 995-1002.

 

 

 

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