Oral Presentation Palliative Care Nurses Australia Conference 2020

Families perspective on end-of life care in the ICU: a qualitative meta-synthesis. (70422)

Alysia Coventry 1 , Dr. Rosemary Ford 2 , Dr. John Rosenberg 3 , Professor Elizabeth McInnes 4
  1. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VICTORIA, Australia
  2. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Ballarat, Victoria, Australia
  3. School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Brisbane, Australia
  4. Nursing Research Institute, St Vincent’s Health Australia Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Melbourne, Victoria, Australia

Introduction/Background/Significance: Family-centred care is recognised to enhance the quality of end-of-life care (EOLC) in the intensive care unit (ICU). An evidence-based approach to preparing families for the dying process, death and bereavement is required. Globally, EOLC is reported to fall below the expectations of patients and their families, attributable to a lack of clear and consistent guidance for clinicians. Families are optimally positioned to identify important components of care at the end of life, however their views and needs are under-represented in key policy and guidance documents. To date, qualitative studies of family’s views on the adequacy of EOLC following withdrawal of life-support have not been synthesised.

Aim: To synthesise qualitative studies of patients’ families’ experiences and perceptions of EOLC in the ICU, following the withdrawal of life support.

Methods: Qualitative meta-synthesis was conducted using meta-aggregation and thematic analysis. A comprehensive search of 18 electronic databases for qualitative studies published between January 2005 and February 2019 was conducted. ENTREQ guidelines were followed in the reporting of this meta-synthesis.

Results: Thirteen studies met the inclusion criteria. A conceptual ‘Model of Preparedness’ was developed reflecting the elements of EOLC most valued by families: ‘End-of-life communication’; ‘Valued attributes of patient care’; ‘Preparing the family’; ‘Supporting the family’, and; ‘Bereavement care’.

Discussion/Implications for practice: Understanding the role and characteristics of preparedness during EOLC will inform future nursing practices in the ICU and may improve family member satisfaction with care and their recovery from loss. Nurses are optimally positioned to address the perceived shortfalls in EOLC. These findings have implications for education, policy and standards for EOLC in the ICU.

Conclusion: Families have unmet needs related to communication, support and bereavement care. A family-centred approach to EOLC that acknowledges the values and preferences of families in the ICU is important. Effective communication and support are central to preparedness and if these care components are in place, families can be better equipped to manage the death, their sadness, loss and grief. The findings suggest that clinicians may benefit from specialist EOLC education, in order to support families and guide the establishment of preparedness.