Table 1 Study intervention: a three-step communication strategy
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 |