Effectiveness of interventions to prevent or treat prolonged grief symptoms among families of the patients who die in intensive care units: A systematic review and meta-analysis.

BACKGROUND: Family members of ICU decedents are at high risk of adverse psychological outcomes, including prolonged grief. However, evidence regarding the effectiveness of existing family support interventions remains limited. OBJECTIVES: To evaluate the effectiveness of interventions to prevent or treat prolonged grief symptoms among families of patients who die in ICUs. METHODS: A systematic review and meta-analysis were conducted following JBI methodology. Family members of ICU decedents were included. Databases searched included CINAHL, Academic Search Complete, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, APA PsycINFO, Web of Science Core Collection, and Scopus. The primary outcome was prolonged grief symptoms. Secondary outcomes included post-traumatic stress symptoms, anxiety and depression symptoms. Mean differences (MD) were pooled using random-effects models with 95% CI. Certainty of the evidence was assessed using the GRADE approach. RESULTS: Eight studies were included. Evidence regarding prolonged grief symptoms at six months was uncertain, with no consistent pooled effect observed (MD 0.50; 95% CI -6.41 to 7.41; very low certainty). The pooled estimate was limited by the small number of studies contributing to the meta-analysis. Post-traumatic stress symptoms were reduced at three months (MD -9.29; 95% CI -13.36 to -5.23; low certainty) and at the longest available follow-up, with very low certainty. Small reductions in anxiety and depression symptoms were observed with very low certainty. CONCLUSIONS: Evidence regarding the effects of ICU-based interventions on prolonged grief symptoms is uncertain. Some interventions may reduce post-traumatic stress, anxiety and depression symptoms. Future research should prioritise powered trials evaluating sustained, theory-driven, multicomponent, and culturally adapted interventions spanning the dying process and bereavement, with explicit attention to grief adaptation mechanisms and longer follow-up periods. IMPLICATIONS FOR CLINICAL PRACTICE: Current evidence is uncertain to support recommendations for preventing or treating prolonged grief symptoms. Structured information provision, psychoeducational and supportive approaches, and opportunities for emotional expression delivered before death, during the dying process, and throughout bereavement may be considered as components of family-centred ICU care.