title: A process evaluation of the bereavement follow-up programme in Critical Care at the Queen Elizabeth University Hospital, Glasgow
Creators: name: Labram, Aileen Heather
Publisher: name: University of Glasgow
Year: 2022

description: Background Mortality figures in critical care are high with the trajectory of dying often unpredictable. The negative impact of unexpected and sudden death on relatives is well documented and can make the grieving process significantly more difficult. There is no current research in the UK that either surveys the availability of follow-up or examines individual bereavement follow-up interventions. This study is a process evaluation of the bereavement follow-up programme implemented in 2018 in the Critical Care Unit at the Queen Elizabeth University Hospital, Glasgow. The intervention consists of a condolence card given at time of death along with the When Someone Has Died information pack. A letter and card are sent out after three months, giving relatives the opportunity to contact the bereavement team. Methods This is a mixed methods study and follows the UK Medical Research Council’s guidelines for process evaluations. A process evaluation was chosen as the most appropriate method of study as it allows researchers to pick apart the complexity of interventions by looking at implementation process, acceptability, and mechanisms of change including the impact of contextual factors. The beravement follow up programme is an intervention in current practice and therefore this project aligns to a pragmatic process evalaution. Quantitaitve data from critical care mortality figures, bereavement follow-up spreadsheets for 2019 and 2020, along with a telephone questionnaire of 16 bereaved relatives over a two-month period, examine the implementation process and acceptability variables. Semi-structured interviews were carried out with 6 consultants, 3 nurses, 1 hospital chaplain, and 4 bereaved relatives who had returned for a follow-up meeting. The interviews examine the experience of the intervention through in-depth qualitative data. The results are considered in the context of a large critical care department, the organisation, and the wider social and global context. Findings Implementation process results show that overall fidelity is impacted by issues around giving information at time of death, collecting information on the nearest/closest friend or relative and relying on a single contact. Acceptability of bereavement follow-up is high with over 90 per cent of relatives answering the telephone questionnaire stating that critical care should contact bereaved families. However, engagement with the intervention is low, despite this, the benefits for relatives who return for a meeting based on analysis of the semi-structured interviews go beyond answering questions and clarifying events. This suggests a gap in both how the programme is offered and the understanding of the mechanisms of change in bereavement follow-up. Stakeholder data indicate that, while bereavement support is viewed as important, time and resource constraints are barriers to its implementation. Attending a meeting is a learning experience for clinicians and helps inform practice. Conclusion and Recommendations This is a valuable study of a current bereavement follow-up intervention in critical care in the UK. The results of the evaluation show that process improvements are important for the fidelity of the intervention. Acceptability among bereaved families is high. The simple change mechanisms of non-abondonemnt and recognition of significant loss are important. However, there are opportunities to better understand gaps in engagement with the programme, the complex change mechanisms and the optimum process for bereavement follow-up. Recommendations for the current programme are made, including the need for resources and funding. Essential to the recommendations is a greater acknowledgement of the importance of bereavement follow-up at organisational level, and more policy and guidance from professional organisations. The study has implications for the wider critical care community and opportunity for more collaborative research.