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To investigate the experience with and progress of the implementation of a Family Support Intervention (FSI) into adult intensive care units (ICUs) as part of the cluster-randomised FICUS trial.
A mixed-methods process evaluation using a multiple case study approach guided by the normalisation process theory.
This study took place between June 2022 and July 2023 in eight Swiss ICUs randomised to the intervention arm. A tailored implementation strategy was used to introduce the multicomponent FSI, consisting of a new family nursing role and a family care pathway, into interprofessional ICU teams. Participants were 40 ICU key clinical partners. Qualitative data were collected twice, early (3–6 months) and mid-implementation (9–12 months), using small group interviews. A questionnaire with psychometric measures (Acceptability of Intervention Measure, Feasibility of Intervention Measure, Intervention Appropriateness Measure, Normalisation Measure Development Questionnaire) was administered at mid-implementation. RITA pragmatic rapid thematic analysis and descriptive statistics were used to analyse the data. Qualitative and quantitative results were then compared across ICUs (cases).
Findings indicated the desired progress of the FSI integration overall and across cases, with high acceptability and appropriateness ratings but only moderate to high feasibility scores. Study-related barriers were noted in all ICUs (i.e., FSI delivery as part of a clinical trial). Implementation barriers included family nurses' limited capacity and clinician's attitudes towards the FSI. Leadership support and interprofessional collaboration were identified as facilitators. Case-based, integrated findings yielded two implementation pathways, namely early and protracted adopters.
Implementation barriers were related to the feasibility of FSI delivery within the study context that required a high degree of standardisation and protocol adherence. Implementation progress was shaped by an interprofessional culture of family care, sufficient staff and time resources, and leadership support. The study's findings will inform future implementation of complex health interventions in ICUs.
Good reporting of a Mixed-Methods Study (GRAMMS).
Within the FICUS trial, a patient and family advisory board with a patient expert, three family members and a patient with own lived experience of critical care collaborate with the research team.
To synthesise evidence on the impact of pre- and post-loss family support interventions on bereavement outcomes and families' perceptions of their usefulness and benefits in specialist palliative care.
A rapid mixed-methods systematic review drawing on JBI and Cochrane guidance. Study quality was appraised using the Mixed-Methods Appraisal Tool. Qualitative and quantitative data were analysed using a meta-aggregation and narrative analysis approach combined with narrative synthesis.
We searched Medline, CINAHL, PsycINFO, Embase and Cochrane Library and included articles published between 2004 and 2024 that evaluated pre- and post-loss family support in specialist adult palliative care and assessed bereavement outcomes.
The search yielded 3682 records. We included thirty-nine mostly moderate to high-quality studies (57% quantitative). Results suggest that pre-loss support, like family-focused interventions and communication during dying, may mitigate post-loss anxiety, depression and grief. Individual and group post-loss support interventions may reduce anxiety, distress and grief while improving well-being. Families desire individualised and comprehensive pre- and post-loss support, with few not needing or accepting it. Stigma associated with bereavement, support and barriers can hinder access.
Included studies demonstrated mixed effects of pre- and post-loss family support interventions, suggesting they are beneficial when accessible and tailored to family needs. High-quality intervention research assessing a broader range of family bereavement outcomes is needed.
Palliative care nurses and other health professionals should tailor their care to family needs, start family support before patient death and ensure equitable access to bereavement services. Our results may guide palliative care professionals in designing effective, personalised and accessible services and policymakers in allocating resources for bereavement care. Findings highlight research needs, including investigating barriers to care and accessibility of services. High-quality research is needed to understand who benefits the most from health-promoting bereavement support and why.
We adhered to the PRISMA guideline.
No Patient and Public Contribution.
Open Science Framework https://osf.io/36jeu
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