Preparing Families for the Dying Process

描述(申请人提供)：重症监护死亡占住院死亡的大多数，大多数死亡发生在生命维持治疗被暂停和撤销之后。家庭成员在参与这些临终决定和亲人的死亡过程时会感受到负担。这些家庭成员有很高的心理社会和身体问题的风险。家属报告说，在决策过程中得到了准备和支持，但在生命维持治疗停止后，没有为死亡过程做好准备或提供支持。我们解决了一个重要的临床问题，即如何最好地为危重患者家属的死亡过程做好准备和提供支持。 持续治疗已被撤回。这项研究的广泛和长期目标是开发以家庭为重点的干预措施，帮助停用生命维持素治疗后的家庭，并改善亲人去世后的家庭结果。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，使家庭为停止生命维持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，对在医疗重症监护病房中有危重家庭成员的家庭样本进行试点测试，以测试这一干预措施、研究方案和拟议的结果措施(压力、焦虑、抑郁、创伤后应激症状、健康和对家庭幸福的看法)的可接受性。我们将对30个家庭(大约60个家庭成员)进行这项研究，采用试验性的两组设计。我们假设，接受干预的家庭将会有更少的压力、焦虑、抑郁和创伤后应激症状，更好的健康，以及更好的家庭幸福感。由于这是一项试验性研究，我们将重点关注成果和实现成果的过程，重点是确定障碍、促进者和干预忠诚度，以评估更大规模的 学习。

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represent the majority of hospital deaths with most deaths occurring after life-sustaining therapy is withheld and withdrawn.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the decision-making process, but not prepared or supported for the dying process after life- sustaining therapy is withdrawn.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of critically ill patients for the dying process of their family member after life sustaining therapy has been withdrawn.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