We wished to assess practice, staff attitudes and desire for change in the way dying patients are cared for in intensive care units (ICUs) in Scotland. A questionnaire was distributed to all 23 general ICUs in Scotland, for medical and nursing staff of all grades to fill in. A dying patient was defined as one in whom a decision had been taken to withdraw or withhold intensive care in the expectation that the patient would die in less than 12 hours; respondents first answered questions about current practice in their ICU, immediately followed by questions concerning ideal practice. The response rate was 62% with the majority of staff being satisfied with current practice, although even the respondents who were satisfied overall would significantly change delivery of care in some areas. A small number (<1%) would not reduce or stop ventilatory, cardiovascular or renal support. In this survey, the withdrawal and limitation of life-sustaining treatment in Scottish ICUs was common, but variable in practice. Institution of a common care pathway at the end of life would allow each unit to decide on the best process to facilitate high-quality end-of-life care, and have robust systems in place to ensure it is consistently delivered.
Purpose of review The aim of this review is to examine bereavement follow-up intervention studies in critical care, with the purpose of integrating results on the timing, content, aims and outcomes of interventions. The impact of a death in critical care is well documented, and bereavement follow-up is recognised as an important topic, but there is limited research with little consensus on the content and structure of interventions. Recent findings A total of 18 papers were selected; 11 are intervention studies, with only one randomised control trial. Six papers were from national surveys and are not the focus of this review. Bereavement follow-up mainly consisted of information giving, condolence interventions, telephone calls and meetings with families. The timing, content, aims and outcomes depended on the intervention and were influenced by the design of the study. Summary Overall, bereavement follow-up is acceptable for relatives but outcomes are mixed. Calls for more research are valid, but how do we utilise the current research to better inform the critical care community? Researchers suggest that bereavement follow-up interventions need to be designed with specific aims and outcomes, in collaboration with bereaved families that are appropriate to the intervention.
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