title: Development of a post-intensive care unit storytelling intervention for surrogates involved in decisions to limit life-sustaining treatment.
abstract: OBJECTIVE
  Surrogates involved in decisions to limit life-sustaining treatment for a loved one in the intensive care unit (ICU) are at increased risk for adverse psychological outcomes that can last for months to years after the ICU experience. Post-ICU interventions to reduce surrogate distress have not yet been developed. We sought to (1) describe a conceptual framework underlying the beneficial mental health effects of storytelling, and (2) present formative work developing a storytelling intervention to reduce distress for recently bereaved surrogates.
  
  
  METHODS
  An interdisciplinary team conceived the idea for a storytelling intervention based on evidence from narrative theory that storytelling reduces distress from traumatic events through emotional disclosure, cognitive processing, and social connection. We developed an initial storytelling guide based on this theory and the clinical perspectives of team members. We then conducted a case series with recently bereaved surrogates to iteratively test and modify the guide.
  
  
  RESULTS
  The storytelling guide covered three key domains of the surrogate's experience of the patient's illness and death: antecedents, ICU experience, and aftermath. The facilitator focused on the parts of a story that appeared to generate strong emotions and used nonjudgmental statements to attend to these emotions. Between September 2012 and May 2013, we identified 28 eligible surrogates from a medical ICU and consented 20 for medical record review and recontact; 10 became eligible, of whom 6 consented and completed the storytelling intervention. The single-session storytelling intervention lasted from 40 to 92 minutes. All storytelling participants endorsed the intervention as acceptable, and five of six reported it as helpful.
  
  
  CONCLUSIONS
  Surrogate storytelling is an innovative and acceptable post-ICU intervention for recently bereaved surrogates and should be evaluated further.
authors: Division of General Internal Medicine,Department of Medicine,University of Pittsburgh,Pittsburgh,Pennsylvania.
authors: Yael
authors: Y
authors: Schenker
authors: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania.
authors: Mary Amanda
authors: MA
authors: Dew
authors: Department of Psychiatry,University of Pittsburgh,Pittsburgh,Pennsylvania.
authors: Charles F
authors: CF
authors: Reynolds
authors: Section of Palliative Care and Medical Ethics,University of Pittsburgh,Pittsburgh,Pennsylvania and Palliative and Supportive Institute,University of Pittsburgh Medical Center,Pittsburgh,Pennsylvania.
authors: Robert M
authors: RM
authors: Arnold
authors: Division of General Internal Medicine,Department of Medicine,University of Pittsburgh,Pittsburgh,Pennsylvania.
authors: Greer A
authors: GA
authors: Tiver
authors: Division of General Internal Medicine,Department of Medicine,University of Pittsburgh,Pittsburgh,Pennsylvania.
authors: Amber E
authors: http://orcid.org/0000-0003-1080-6270
authors: AE
authors: Barnato
mesh_terms: D016223:Advance Directives / Q000523:psychology*; D003142:Communication; D005190:Family / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000379:methods*; D026712:Value of Life
keywords: Decision making; Family members; Intensive care unit; Mental disorders; Role of surrogates; Terminal care