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Table 1 Study intervention: a three-step communication strategy

From: Guiding intensive care physicians’ communication and behavior towards bereaved relatives: study protocol for a cluster randomized controlled trial (COSMIC-EOL)

Three-step strategy Preparation for death
The physician and the nurse meet the relative to:
During the dying and death process: After the patient’s death
The physician and the nurse meet the relative to:
Themes ▪ Prepare the relative for the patient’s imminent death
▪ Provide an opportunity for relatives to ask questions
▪ Provide an opportunity for relatives to express their feelings and emotions
▪ Encourage relatives to talk to the patient and say good-bye
▪ Discuss being present at the time of death
▪ Discuss possible involvement in the patient’s physical care
▪ Discuss spiritual beliefs and needs
▪ The physician enters the patient’s room at least once to check whether the relatives have any questions or apprehensions and to check their comprehension of what is happening
▪ The nurse enters the patient’s room at least once to check the relatives’ comfort and needs, and whether they have any questions
▪ Express their condolences
▪ Elicit and answer questions about the patient’s death
▪ Provide an opportunity for relatives to express their feelings
▪ Offer them the option of contacting the team during their bereavement
Mnemonic PRECISE:
▪ Prepare
▪ Relatives for the patient’s death
▪ Elicit questions and emotions
▪ Communication about presence at time of death and
▪ Involvement in care
▪ Spiritual needs
▪ Encourage relatives to say good-bye to the patient
RAAP:
▪ Reassure relatives regarding their spiritual beliefs, the tenets of palliative care, the expected time of death, and their role in the patient’s care
▪ Answer relatives’ questions
▪ Attentive listening
▪ Propose emotional support
CIAO:
▪ Condolences: express condolences
▪ Instigate questions about the patient’s ICU stay and death
▪ Acknowledge emotions
▪ Option to contact the team during their bereavement