Objectives: 

Evaluate the efficacy of interventions to improve symptoms for ICU surrogates at highest risk of developing psychologic distress: those facing end-of-life care decisions.

Data Sources: 

MEDLINE, CINAHL, PsycInfo, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched through April 16, 2022.

Study Selection: 

Following an a priori protocol, randomized trials of interventions delivered to surrogates of adult ICU patients who died or had high likelihood of mortality evaluating surrogate symptoms were identified.

Data Extraction: 

Two reviewers performed screening and data extraction and assessed risk of bias (Cochrane Risk of Bias [RoB] 2 tool). Trials were eligible for meta-analysis if group mean symptom scores were provided at 3 or 6 months. Pooled effects were estimated using a random effects model. Heterogeneity was assessed (Cochrane Q, I²). Certainty of evidence was assessed (Grading of Recommendations Assessment, Development and Evaluation).

Data Synthesis: 

Of 1,660 records, 10 trials met inclusion criteria representing 3,824 surrogates; eight were included in the meta-analysis. Overall RoB was rated Some Concerns. Most (n = 8) interventions focused on improving communication and enhancing psychologic support in the ICU. All trials measured anxiety, depression, and posttraumatic stress. Significant improvement was seen at 3 months (depression, mean difference [MD], –0.68; 95% CI, –1.14 to –0.22, moderate certainty; posttraumatic stress, standardized MD, –0.25; 95% CI, –0.49 to –0.01, very low certainty) and 6 months (anxiety, MD, –0.70; 95% CI, –1.18 to –0.22, moderate certainty). Sensitivity analyses suggest significant findings may be unstable. Subgroup analyses demonstrated differences in effect by trial location, interventionist, and intervention dose.

Conclusions: 

Communication and psychological support interventions in the ICU yielded small but significant improvement in psychological symptoms with moderate to very low certainty evidence in a prognostically-enriched sample of ICU surrogates facing end-of-life care decisions. A new approach to interventions that extend beyond the ICU may be needed.

中文翻译：

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干预措施能否改善 ICU 代理人面临临终决定的症状？预后丰富的系统回顾和荟萃分析

目标： 

评估干预措施的有效性，以改善 ICU 代理人出现心理困扰风险最高的症状：那些面临临终关怀决定的人。

数据源： 

MEDLINE、CINAHL、PsycInfo、Embase、Cochrane Central Register of Controlled Trials 和 ClinicalTrials.gov 的检索截止日期为 2022 年 4 月 16 日。

研究选择： 

按照先验方案，确定了对死亡或死亡可能性较高的成年 ICU 患者的代理人进行干预措施的随机试验，以评估代理人的症状。

数据提取： 

两名评审员进行了筛选和数据提取，并评估了偏倚风险（Cochrane 偏倚风险 [RoB] 2 工具）。如果在 3 或 6 个月时提供组平均症状评分，则试验符合荟萃分析条件。使用随机效应模型估计汇总效应。评估异质性（Cochrane Q, I ²）。评估了证据的确定性（建议评估、制定和评估的分级）。

数据综合： 

在 1,660 条记录中，10 项试验符合纳入标准，代表 3,824 名代理人；荟萃分析中纳入了八项。总体而言，RoB 被评为“有些担忧”。大多数（n = 8）干预措施侧重于改善沟通和加强 ICU 的心理支持。所有试验都测量了焦虑、抑郁和创伤后压力。3 个月时出现显着改善（抑郁，平均差 [MD]，–0.68；95% CI，–1.14 至 –0.22，中等确定性；创伤后应激，标准化 MD，–0.25；95% CI，–0.49 至 –0.01 ，非常低确定性）和 6 个月（焦虑，MD，–0.70；95% CI，–1.18 至 –0.22，中等确定性）。敏感性分析表明重大发现可能不稳定。亚组分析表明试验地点、干预者和干预剂量的效果存在差异。

结论： 

ICU 中的沟通和心理支持干预措施对心理症状产生了微小但显着的改善，在面临临终护理决策的 ICU 替代者的预后丰富样本中，具有中度至极低确定性的证据。可能需要一种超越 ICU 的新干预方法。