ABSTRACT
BACKGROUND: Family members of critically ill patients face considerable uncertainty and distress during their close others' intensive care unit (ICU) stay. About 20-60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation. METHODS: To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members' satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members' mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference. DISCUSSION: This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being. TRIAL REGISTRATION: ClinicalTrials.gov NCT05280691 . Prospectively registered on 20 February 2022.
Subject(s)
Critical Illness , Ficus , Adult , Anxiety/diagnosis , Anxiety/prevention & control , Critical Illness/therapy , Family/psychology , Humans , Intensive Care Units , Multicenter Studies as Topic , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVES: To ascertain the degree of death anxiety in healthcare professionals and their preventive practices during the ongoing pandemic and to find correlations between these two variables. METHODS: This cross-sectional study was conducted on healthcare professionals working in Combined Military Hospital, Lahore, Pakistan, from July 2020 to February 2021. A descriptive online questionnaire was distributed to measure demography, death anxiety using Collette-Lester Fear of Death Scale Revised and preventive practices using the prevention section of WHO European Region COVID-19 survey tool and guidance. Data were analyzed using SPSS version 24. RESULTS: Out of 136 subjects, 65 (47.8%) were male and 71 (52.2%) were female. Median (IQR) age of the participants was 28 (26-40) years. Median total degree of death anxiety was 83 (66-107). The four subscales showed Median (IQR) scores as follows: your own death 18 (12-27), your own dying 20 (15-27), the death of others 23 (18-28), and the dying of others 22 (16-29). Death anxiety was mild in 55 (40.4%), moderate in 65 (47.8%) and high in 16 (11.8%) participants. Significant association of female gender (p=0.002), experience of death of a patient (p=0.001) or loved one (p=0.001) was found with death anxiety. Zero participants recorded a high preventive practice score. CONCLUSION: A significant proportion of healthcare professionals suffered from undiagnosed moderate levels of death anxiety. The level of preventive practices amongst healthcare professionals was moderate to low. Death anxiety had no correlation with preventive practices. Further study is required to investigate the reason behind these unconventional findings. © 2022, Khyber Medical University. All rights reserved.