Critical care deaths represent the majority of hospital deaths with most deaths occurring after life-sustaining therapy is withheld and withdrawn. Family members experience burden as they participate in these end-of-life decisions and the dying process of loved ones. These family members are at high risk for psychosocial and physical problems. Families have reported being prepared and supported through the decision-making process, but not prepared or supported for the dying process after life- sustaining therapy is withdrawn. We address the important clinical problem of how best to prepare and support families of critically ill patients for the dying process of their family member after life sustaining therapy has been withdrawn. The broad, long-term objective of this research is to develop family-focused interventions that will help families following withdrawal of life-sustainin therapy and improve family outcomes after the death of a loved one. The first specific aim for the proposed investigation is to develop and refine an educational and psychological support intervention to prepare families for the dying process after withdrawal of life-sustaining therapy. The second specific aim is to pilot test the acceptability of this intervention, the study protocol and the proposed outcome measures (stress, anxiety, depression, post-traumatic stress symptoms, health, and perception of family well-being) with a sample of families with a critically ill family member in a medical intensive care unit after a decision has been made to withdraw life- sustaining therapy. We will conduct this study with 30 families (approximately 60 family members) using an experimental two group design. We hypothesize that families receiving the intervention will have deceased stress, anxiety, depression and post- traumatic stress symptoms, better health, and an improved perception of family well- being. Because this is a pilot study, we will focus on both outcomes and the processes to achieve them with emphasis on determining barriers, facilitators, and intervention fidelity, to assess feasibility of a larger study.

Public Health Relevance

This study will test an intervention to prepare families for the dying process after technology is withdrawn in the intensive care setting. This study will assist nurses, physicians and other clinicians to understand how best to prepare families for this difficult process. The results of the study will be published and presented in local and national meetings to health professionals and others who would benefit from information related to how to help these grieving family members.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-NRCS-G (08))
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Mccloskey, Donna J
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University of Maryland Baltimore
Schools of Nursing
United States
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Wiegand, Debra L; Grant, Marian S; Cheon, Jooyoung et al. (2013) Family-centered end-of-life care in the ICU. J Gerontol Nurs 39:60-8