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ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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4/2020
vol. 52
 
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abstract:
Letter to the Editor

Fighting a family tragedy: family-centred care in times of the COVID-19 pandemic

Bjoern Zante
1
,
Sabine A. Camenisch
2
,
Marie-Madlen Jeitziner
1
,
Beatrice Jenni-Moser
1
,
Joerg C. Schefold
1

1.
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
2.
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
Anaesthesiol Intensive Ther 2020; 52, 4: 336–338
Online publish date: 2020/10/30
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Dear Editor,
The COVID-19 pandemic poses unprecedented challenges to intensive care medicine worldwide. Anticipating a mass casualty imposed by COVID-19, intensive care unit (ICU) resources have been increased considerably. Unfortunately, despite great efforts, and even if the best individual medical care can be provided, long-term hospitalisation, disability, and death cannot be prevented with certainty. This situation poses particular emotional challenges for relatives of patients affected by COVID-19.
The post-intensive care syndrome-family (PICS-F) was proposed to refer to acute or chronic psychological effects on the relatives of ICU patients [1]. Uncertainty about the patients’ future, the course of illness, his/her survival, and the unfamiliar environment of an ICU may have an impact on the relatives’ psychological conditions (e.g. anxiety, stress, depression, sleep disturbances). In fact, family members may show a high prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) [2]. In the pre-COVID-19 era, family-centred care concepts were used to address PICS-F (Table 1) [3]. Currently, the burden among relatives of ICU patients may be high, with the current situation posing new challenges for family-centred care. Dedicated communication is regarded as a key concept of family-centred care and a cornerstone for PICS-F prevention [4]. During the COVID-19 pandemic, face-to-face communication with family members in the ICU is scarce. Thus, building a trusting relationship with the ICU team may be difficult. Visiting restrictions and the enormous workload among ICU staff further limits the ability to provide sufficient communication and information to relatives [5]. Therefore, opportunities for relatives to address needs, to take part in decision-making, and to receive support measures (family care concepts, spiritual support, social worker) are often limited, which may support the development of PICS-F [3]. Additionally, reduced family presence and caregiving at the bedside due to restricted visiting hours may worsen PICS-F [3]. In cases of dying patients, end-of-life conferences and support of the dying can often not be facilitated, which may augment PICS-F [3]. In light of available guidelines for family-centred care in the ICU, it must be noted that several of these concepts may not be feasible during the COVID-19 pandemic (Table 1) [4]. Hence, novel unconventional strategies should be implemented that enable...


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