Developing and testing a nurse-ledintervention to support bereavement inrelatives in the intensive care (BRIC study): a protocol of a pre-post intervention study

Background:When a patient is approaching death in the intensive care unit (ICU), patients’relatives must make arapid transition from focusing on their beloved one’s recovery to preparation for their unavoidable death. Bereavedrelatives may develop complicated grief as a consequence of this burdensome situation; however, little is knownabout appropriate options in quality care supporting bereaved relatives and the prevalence and predictors ofcomplicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is todevelop and implement a multicomponent bereavement support intervention for relatives of deceased ICUpatients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression andposttraumatic stress in bereaved relatives.

Methods:The study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in theNetherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities andevidence-based practices, a nurse-led intervention will be developed and implemented during the study period.This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, willserve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety,depression and posttraumatic stress. Differences between the baseline and follow-up measurements will becalculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, riskprofiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted.

Discussion:The newly developed intervention has the potential to improve the bereavement process of therelatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression,anxiety and posttraumatic stress, might decrease.