Family-centred care at end of life in critical care: A retrospective descriptive study

Background: A family-centred approach to care can aid family coping at the end of life in critical care. Yet little is known about how families’ preferences for involvement in care planning and decision-making, are assessed and supported. Aim: To explore how family involvement and assessment of their needs at the end of life are facilitated and supported in critical care Methods: A descriptive study utilising a retrospective audit of the medical records of 50 patients who received end-of-life care in one critical care unit. Findings: Next-of-kin were documented in 96% of records, with the spouse/partner fulfilling the role in 46% of cases. A Goals of Care Summary was completed in 74.0% of cases with 62.2% of patients for treatment limitation, 10.8% for supportive/palliative care, and 21.6% identified as terminal. In 75.7% of cases there was evidence of next-of-kin/family consultation and formal family meetings were held in 90.0% of cases. There was also evidence of supporting family involvement and needs before and after death. 22.0% received bereavement support and in 34.0% cultural/religious practices were facilitated after patient death. Discussion: Clinicians rely on family members to inform care planning and decision-making. Hence, a family-centred approach to care is essential in critical care practice. Conclusion: Opportunities for next-of-kin or extended family to be involved in patient care planning and decision making are key to ensuring family members to be as involved as they wish, kept informed and receive bereavement support. Addressing patients’ and families' cultural/religious needs and other needs that extend beyond the clinical setting are essential to a family-centred approach to care at the end of life.