Development of a clinical guide for identifying spiritual distress in family members of patients in the intensive care unit
CCCF ePoster library. Roze des Ordons A. 11/11/19; 285176; EP29
Amanda Roze des Ordons
Amanda Roze des Ordons
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Roze des Ordons, Amanda L.1-3; Sinclair, Shane4; Sinuff, Tasnim5; Grindrod-Millar, Kathleen6; Stelfox, Henry T.1,2,7

1. Alberta Health Services Calgary Zone, Calgary, Canada
2. Department of Critical Care Medicine, University of Calgary, Calgary, Canada
3. Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, Canada
4. Faculty of Nursing, University of Calgary, Calgary, Canada
5. Department of Medicine, University of British Columbia, Vancouver, Canada
6. University of Calgary, Calgary, Canada
7. Department of Community Health Sciences, University of Calgary, Calgary, Canada

Introduction: Current guidelines for family-centered care in the Intensive care unit (ICU) recommend offering spiritual support to families of critically ill patients.1 Spirituality is important for many family members of patients in the ICU,2 with many factors related to the patient, family, and ICU context can contribute to spiritual distress among family members.3 Clinicians without training in spiritual care experience have difficulty identifying when family members are experiencing spiritual distress.4,5

Objectives: The purpose of this study was to develop a guide to help clinicians working in the ICU identify family members who may benefit from specialized spiritual support.

Methods: We performed a cross-sectional study involving a national sample of spiritual health practitioners, family members and ICU clinicians. A panel of 21 spiritual health practitioners participated in a modified Delphi process6 to achieve consensus on items that suggest spiritual distress among family members of patients in the ICU. The survey was developed from a scoping review of the literature7 and interviews and focus groups with family members of previous ICU patients (n=10), spiritual health practitioners (n=18), and clinicians working in ICU settings (nurses, respiratory therapists, social workers, indigenous health liaison workers, physicians; n=32)8. The Delphi process involved 3 rounds of remote review followed by an in-person conference and a final round of panelist feedback. Feedback on the final set of items was obtained from an end-user group of 4 family members and 6 ICU clinicians (1 social worker, 2 nurses, 3 physicians). Quantitative data was summarized with descriptive statistics. Content analysis was used to analyze written comments.9 

Results: A total of 220 items were iteratively reviewed and rated by Delphi panelists. By the end of the Delphi process, forty-six items had been identified as essential for inclusion. End-user feedback recommended minor revisions to wording and sequence. The final set of items was developed into a clinical guide, including an introduction (number of items, n=1), definitions (n=2), risk factors (n=10), expressed concerns (n=12), emotions (n=7), and behaviours (n=7) that may suggest spiritual distress, questions to identify spiritual needs (n=6), and an approach to introducing spiritual support (n=1).

Conclusions: We have developed an evidence-informed clinical guide to help clinicians in the ICU identify family members experiencing spiritual distress. Evaluation of the process and impact of implementing the guide in clinical practice is needed.

  1. Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Cox CE, Wunsch H, Wickline MA, Nunnally ME, Netzer G, Kentish-Barnes N, Sprung CL, Hartog CS, Coombs M, Gerritsen RT, Hopkins RO, Franck LS, Skrobik Y, Kon AA, Scruth EA, Harvey MA, Lewis-Newby M, White DB, Swoboda SM, Cooke CR, Levy MM, Azoulay E, Curtis JR. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45:103-128.
  2. Swinton M, Giacomini M, Toledo F, Rose T, Hand-Breckenridge T, Boyle A, Woods A, Clarke F, Shears M, Sheppard R, Cook D. Experiences and expressions of spirituality at the end of life in the intensive care unit. Am J Respir Crit Care Med. 2017;195:198-204.
  3. Roze des Ordons AL, Sinuff T, Stelfox HT, Grindrod-Millar K, Seemann J, Sinclair S. Spiritual distress in family members of critically ill patients: perceptions and experiences. ​[Submitted for publication].
  4. Roze des Ordons AL, Sinuff T, Stelfox HT, Kondejewski J, Sinclair S. Spiritual distress within inpatient settings – a scoping review of patients' and families' experiences. J Pain Symptom Manage2018;56:122–145.
  5. Balboni MJ, Sullivan A, Enzinger AC, Epstein-Peterson ZD, Tseng YD, Mitchell C, Niska J, Zollfrank A, VanderWheele TJ, Balboni TA. Nurse and physician barriers to spiritual care provision at the end of life. J Pain Symptom Manage. 2014;48;400-410.
  6. Hsu CC, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007;12:1-8.
  7. Roze des Ordons AL, Sinuff T, Stelfox HT, Kondejewski J, Sinclair S. Spiritual distress within inpatient settings - A scoping review of patients' and families' experiences. J Pain Symptom Manage. 2018;56:122-145.
  • Roze des Ordons AL, Stelfox HT, Sinuff T, Grindrod-Millar K, Smiechowski J, Sinclair. Spiritual distress in family members of critically ill patients: perceptions and experiences. J Palliat Med. 2019 Aug 13. doi: 10.1089/jpm.2019.0235. [Epub ahead of print].
  • Braun V, Clarke V, Terry G. Thematic analysis. In: Rohleder P, Lyons AC, eds. Qualitative Research in Clinical and Health Psychology. London (UK): Palgrave Macmillan; 2015:95-113.
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