Preparing Families for the Dying Process

描述（由申请人提供）：重症监护死亡占医院死亡的大多数，大多数死亡发生在暂停和停止生命维持治疗后。家庭成员在参与这些生命终结的决定和亲人的死亡过程时会承受负担。这些家庭成员有很高的心理社会和身体问题的风险。家庭报告说，他们在决策过程中得到了准备和支持，但在停止维持生命的治疗后，他们没有为死亡过程做好准备或得到支持。我们解决了重要的临床问题，即如何最好地为危重患者的家庭成员在生命结束后的死亡过程做好准备和支持 维持治疗已经撤销这项研究的广泛，长期目标是制定以家庭为中心的干预措施，帮助家庭在撤回生命维持治疗后，改善亲人去世后的家庭结局。拟议调查的第一个具体目标是制定和完善教育和心理支持干预措施，使家庭为停止维持生命治疗后的死亡过程做好准备。 第二个具体目标是，在决定停止生命维持治疗后，对一个有危重家庭成员的家庭样本进行初步测试，以确定该干预、研究方案和拟定的结局指标（压力、焦虑、抑郁、创伤后应激症状、健康和家庭幸福感）的可接受性。我们将采用两组实验设计，对30个家庭（约60名家庭成员）进行这项研究。我们假设，接受干预的家庭将有死者的压力，焦虑，抑郁和创伤后应激症状，更好的健康，并改善对家庭幸福的看法。由于这是一项试点研究，我们将重点关注结果和实现这些结果的过程，重点是确定障碍，促进者和干预保真度，以评估更大规模的可行性。 study.

DESCRIPTION (provided by applicant): 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represent the majority of hospital deaths with most deaths occurring after life-sustaining therapy is withheld and withdrawn.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the decision-making process, but not prepared or supported for the dying process after life- sustaining therapy is withdrawn.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families of critically ill patients for the dying process of their family member after life sustaining therapy has been withdrawn.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.