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Review
Intensive care unit interventions to improve quality of dying and death: scoping review
  1. Kazuaki Naya1,
  2. Hideaki Sakuramoto2,
  3. Gen Aikawa3,
  4. Akira Ouchi4,
  5. Yusuke Oyama5,
  6. Yuta Tanaka6,
  7. Kentaro Kaneko7,
  8. Ayako Fukushima2 and
  9. Yuma Ota8
  1. 1 Wakayama Faculty of Nursing, Tokyo Healthcare University, Wakayama, Japan
  2. 2 Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Fukuoka, Japan
  3. 3 College of Nursing, Kanto Gakuin University, Kanagawa, Japan
  4. 4 Department of Adult Health Nursing, Ibaraki Christian University, Ibaraki, Japan
  5. 5 Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  6. 6 Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
  7. 7 School of Nursing, Miyagi University, Miyagi, Japan
  8. 8 Department of Nursing, Tokyo Healthcare University, Tokyo, Japan
  1. Correspondence to Dr Hideaki Sakuramoto; gongehead{at}yahoo.co.jp

Abstract

Background Intensive care units (ICUs) have mortality rates of 10%–29% owing to illness severity. Postintensive care syndrome-family affects bereaved relatives, with a prevalence of 26% at 3 months after bereavement, increasing the risk for anxiety and depression. Complicated grief highlights issues such as family presence at death, inadequate physician communication and urgent improvement needs in end-of-life care. However, no study has comprehensively reviewed strategies and components of interventions to improve end-of-life care in ICUs.

Aim This scoping review aimed to analyse studies on improvement of the quality of dying and death in ICUs and identify interventions and their evaluation measures and effects on patients.

Methods MEDLINE, CINAHL, PsycINFO and Central Journal of Medicine databases were searched for relevant studies published until December 2023, and their characteristics and details were extracted and categorised based on the Joanna Briggs model.

Results A total of 24 articles were analysed and 10 intervention strategies were identified: communication skills, brochure/leaflet/pamphlet, symptom management, intervention by an expert team, surrogate decision-making, family meeting/conference, family participation in bedside rounds, psychosocial assessment and support for family members, bereavement care and feedback on end-on-life care for healthcare workers. Some studies included alternative assessment by family members and none used patient assessment of the intervention effects.

Conclusion This review identified 10 intervention strategies to improve the quality of dying and death in ICUs. Many studies aimed to enhance the quality by evaluating the outcomes through proxy assessments. Future studies should directly assess the quality of dying process, including symptom evaluation of the patients.

  • Palliative Care
  • Symptoms and symptom management
  • Terminal care

https://doi.org/10.1136/spcare-2024-004967

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    Footnotes

    • X @@GenAikawa

    • Contributors KN: conception and design of the study, data search, data collection, data analysis, writing–original draft preparation, project administration. GA, AO, YOta, YT, KK, AF and YOyama: data collection, writing–review and editing. HS: conception and design of the study, data collection, writing–original draft preparation, project administration, supervision, funding acquisition, guarantor.

    • Funding This study was funded by unrestricted grants from New Nursing (grant number N/A).

    • Disclaimer The funding source had no role in the design, practice, or analysis of the study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.