De Stefano C, Normand D, Jabre P, et al. (June 2, 2016.) Family presence during resuscitation: A qualitative analysis from a national multicenter randomized clinical trial. PLOS One. Retrieved Aug. 29, 2017, from www.doi.org/10.1371/journal.pone.0156100
This study is a result of the PRESENCE trial which randomized 570 French family members, who were present in the home of a person in cardiac arrest, into either the intervention or control group. In the intervention group, the resuscitation team routinely asked the family members if they wanted to be present at the side of the patient being resuscitated. The control group didn’t actively ask family members, but allowed them to independently decide their presence.
They then categorized the family member’s perception of their reason to be present or absent during the resuscitation. Four themes emerged:
- Choosing to be actively involved in the resuscitation, which reflected the person’s desire to participate in the resuscitation process, feel emotionally able to be present, to support the patient during CPR and to witness the efforts of the resuscitation. Those who declined to be present felt they needed to protect themselves from witnessing the disturbing scenes of resuscitation.
- Communication between the family member and the emergency team so as to relay the patient’s medical information and develop a sense of satisfaction or dissatisfaction with the team’s efforts.
- Perception of the reality of death was enhanced by the awareness of the patient’s critical condition and solidified by observing the unsuccessful resuscitation.
- Experience and reaction of the relative witnessing (or not) the resuscitation provided a feeling of relief in relation to the patient’s distress, the excessively heroic treatments, and the violence, brutality and dehumanization
Medic Wesley Comments
The focus of this study was the feelings of a patient’s family. Most of the family members felt that by being present, they were able to see for themselves what was done to save their loved ones. They also wanted to be present so the patient wasn’t alone at the end of their life.
During the years I worked in EMS and the ED, it was obvious that family members needed constant feedback during resuscitation. Often, they wanted to be present, but the ED team decided that the procedures performed during resuscitation were too harsh for a non-medical person to deal with. That sentiment still holds true for many providers.
In the EMS setting, family presence was always a given. They could stay in the room or leave. We don’t get to call the shots unless the scene is unstable. Those opting to be present for resuscitation often wanted to know what all the procedures were. We would do our best to carefully educate them. Of course, there were times when the family presence was disruptive because of anger or blame.
I’m not sure if you feel this way, but having the family present, and being able to educate and console them, always gave me a sense of closure on a call. I felt a greater sense of peace when I actively involved the family. I was an advocate not only for the dying patient, but also for their family. The tragedies of this career take a toll on providers. Positive feedback from families who actively participate in the resuscitation is reassuring.
Doc Wesley Comments
I fully agree with Medic Wesley. However, this study goes beyond confirming the reasons family members want to be present during resuscitation. It also provides us with an understanding of their motivations, fears and desires. With this knowledge, we can more effectively communicate with them during the most intense and tragic of circumstances.
Actively encourage family members to be present. Be less concerned with any perceived liability of them witnessing our failures and more focused on their emotional needs. We almost always know early on if a resuscitation is going to be successful.
We know the importance of “treating the family” in these cases. Connect with the family early and determine which of these themes appears to be at play with the family’s emotions. Then, honestly address them when you broach the subject of their presence:
- “I know that this can be hard to watch, but some find great peace in being present to hold the hand of their dying mother;”
- “You know everything important about your father’s medical history and we need your help in caring for him;”
- “We’re doing everything we can but it doesn’t look good at this point. Would you like to be with him?” or
- “If this is disturbing you, please feel free to go into the other room.”
Take the opportunity to read this article and share it with your colleagues. Respected professionals should consistently meet this difficult challenge.