Effectiveness of interventions to prevent or treat prolonged grief symptoms among families of patients who die in intensive care units: a systematic review protocol

Abstract

Objective: The objective of this review is to evaluate the effectiveness of interventions to prevent or treat prolonged grief symptoms among families of patients who die in the intensive care unit (ICU).

Introduction: Up to 52% of families of patients who die in an ICU may be at risk of experiencing prolonged grief symptoms. This psychological morbidity should be addressed as early as possible through effective interventions.

Inclusion criteria: Studies of adult family members (≥18 years) of adult patients (≥18 years) who died in the ICU after a treatment withdrawal or withholding decision will be considered for inclusion. Family members must be exposed to tailored interventions to prevent or treat prolonged grief symptoms before, during, and/or after the patient's death. Randomized and non-randomized controlled trials; before and after studies; and interrupted time-series, cohort, and case-control studies will be considered.

Methods: The JBI methodology for systematic reviews of effectiveness will be followed. Databases to be searched include CINAHL, Academic Search Complete, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and APA PsycINFO (all via EBSCOhost), as well as PubMed, Web of Science Core Collection, and Scopus. Two independent reviewers will perform the study selection, critical appraisal, and data extraction. Studies will be pooled in meta-analysis, if possible. Heterogeneity will be assessed using the standard χ 2 and I 2 tests. Statistical analyses will be performed using the random-effects model. The fixed-effects model will be used if fewer than 5 studies are included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of evidence, and a Summary of Findings will be presented.