Storytelling in the Early Bereavement Period to Reduce Emotional Distress Among Surrogates Involved in a Decision to Limit Life Support in the ICU: A Pilot Feasibility Trial
Storytelling in the Early Bereavement Period to Reduce Emotional Distress Among Surrogates Involved in a Decision to Limit Life Support in the ICU: A Pilot Feasibility Trial
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DOI：
10.1097/ccm.0000000000002009
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发表时间：
2017-01-01
影响因子：
8.8
通讯作者：
Reynolds, Charles F., III
中科院分区：
文献类型：
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作者：
Barnato, Amber E.;Schenker, Yael;Reynolds, Charles F., III
目的：代理决策者参与决定限制ICU中无行为能力患者的生命支持，其不良情绪健康结果的发生率很高，与悲伤和丧亲的正常过程不同。叙述性自我表露（讲故事）减少了其他创伤经历后的情绪困扰。我们试图评估的可行性，可接受性，以及在ICU的生命支持限制的决定中涉及的丧亲代理人讲故事的耐受性。设计：试点单盲试验。设置：2013年6月至2014年11月期间，在一个单一的卫生系统内的三家医院的五个ICU。主题：ICU患者的丧亲代理人。干预措施：讲故事和控制条件涉及印刷丧亲材料和后续评估。讲故事涉及一个单一的1至2小时的家庭或电话访问由训练有素的干预谁引起的代理story. Measures和主要结果：的主要结果是可行性（率的登记，干预接收，3和6个月的后续行动），可接受性（封闭和开放式结束的研究反馈6个月），和耐受性（急性精神卫生服务转诊）。在53名合格的代理人中，32名（600/o）同意接受治疗分配。代理人的平均年龄为55.5岁（因此，11.8岁），他们为父母（47%），配偶（28%），兄弟姐妹（13%），孩子（3%）或其他关系（8%）做出决定。我们分配了14个对照组和18个讲故事组，18个中的17个（94%）接受了讲故事，14个中的14个（100%）和14个中的13个（94%）对照组，18个中的16个（89%）和18个中的17个（94%）讲故事组完成了3个月和6个月的电话评估。在6个月时，13名控制参与者中有9名（69%）和17名讲故事的参与者中有16名（94%）报告感觉“更好”或“更好”，没有人感觉“更糟”。一名对照组受试者（8%）和一名讲故事的受试者（6%）说这项研究很繁重，一名对照组受试者（8%）希望他们没有参与。没有受试者需要急性精神卫生服务referreration.Conclusion：在这项研究中，讲故事的临床试验是可行的，可接受的，可容忍的。
Objectives: Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. We sought to assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU.Design: Pilot single-blind trial.Setting: Five ICUs across three hospitals within a single health system between June 2013 and November 2014.Subjects: Bereaved surrogates of ICU patients.Interventions: Storytelling and control conditions involved printed bereavement materials and follow-up assessments. Storytelling involved a single 1- to 2-hour home or telephone visit by a trained interventionist who elicited the surrogate's story.Measurements and Main Results: The primary outcomes were feasibility (rates of enrollment, intervention receipt, 3- and 6-mo follow-up), acceptability (closed and open-ended end-of-study feedback at 6 mo), and tolerability (acute mental health services referral). Of 53 eligible surrogates, 32 (600/o) consented to treatment allocation. Surrogates' mean age was 55.5 (so, 11.8), and they were making decisions for their parent (47%), spouse (28%), sibling (13%), child (3%), or other relation (8%). We allocated 14 to control and 18 to storytelling, 17 of 18 (94%) received storytelling, 14 of 14 (100%) and 13 of 14 (94%) control subjects and 16 of 18 (89%) and 17 of 18 (94%) storytelling subjects completed their 3- and 6-month telephone assessments. At 6 months, nine of 13 control participants (69%) and 16 of 17 storytelling subjects (94%) reported feeling "better" or "much better," and none felt "much worse." One control subject (8%) and one storytelling subject (6%) said that the study was burdensome, and one control subject (8%) wished they had not participated. No subjects required acute mental health services referral.Conclusion: A clinical trial of storytelling in this study population is feasible, acceptable, and tolerable.