A Systematic Review of Family Witnessed Resuscitation and Family Witnessed Invasive Procedures in Adults in Hospital Settings Internationally - Part I: Perspectives of Patients and Families.

Background: Medicalization of care has removed family members from loved ones during critical events. Family Witnessed Resuscitation and Family Witnessed Invasive Procedures represent patient / family centered care options that can assist with having the family at the bedside during this perilous time.

Objectives: The objective was to examine the evidence on FWR and FWIP in adults from the perspective of patients and relatives.

Inclusion Criteria: This review considered studies involving adult patients and their relatives, in intensive care units, emergency departments, trauma rooms and general nursing wards.This review examined interventions used for the adoption/implementation of FWR and FWIP including but not limited to: formal policy and guidelines; family facilitator/chaperone role; educational programming; communication approaches; and debriefing.This review considered studies that included the following outcome measures for patients and family members: level of support; stress and anxiety; grief and bereavement; coping; psychological sequelae; and impact of family facilitator/chaperone role, formal family presence policy or protocols, educational programming, communication approaches, and debriefing.Any randomised controlled trials, controlled trials, cohort studies, case-control studies, before and after studies, case series studies, and survey studies were considered for inclusion.

Search Strategy: A comprehensive multistep search was undertaken for English language published and unpublished studies from 1985-2010.

Methodological Quality: Retrieved papers were assessed for methodological quality independently by two reviewers, using appropriate JBI critical appraisal assessment tools.

Data Collection: Findings were extracted using researcher-developed de novo tools, utilizing a framework of experiential, participant, and environmental factors influencing FWR/FWIP. The de novo tools best addressed the data collected.

Data Synthesis: Meta-analysis was not possible due to heterogeneity; all the results of this review are presented in narrative form.

Results: 38 studies were retrieved and after critical appraisal a total of 15 studies were included. Of the seven patient studies, one was a match-control "actual witness" study representing JBI Level IIIA evidence and the remaining "perception of witness" studies were descriptive cross-sectional survey designs representing JBI Level IIIC evidence. Ten family member studies included four with "actual witness" and six with "perception of witness." All family member studies were descriptive cross-sectional survey designs representing JBI Level IIIC evidence. Two studies surveyed both patients and relatives, reducing the number of unique studies to 15.

Conclusions: From the focus of family members with actual resuscitation experience and those with "perception" of witness, there exists strong support/preference for FWR across all countries in the included studies, and the belief that it is a right.

Implications For Practice: Health care organisations should provide family members the option to witness. There is insufficient evidence on FWIP to make policy recommendations.

Implications For Research: There is a need for well-designed randomised controlled designs that test the effectiveness of different approaches to FWR with outcomes that go beyond the level of support for the procedure. NOTE:: This is Part I of the systematic review report. Part I of the review report will explicate the perceptions of patients and family members on family witnessed resuscitation (FWR) and family witnessed invasive procedures (FWIP) in the adult population in emergency departments, intensive care units and general hospital wards internationally. Part II of the review report will explicate the perceptions of physicians, nurses and other healthcare providers regarding this phenomenon.Both review reports (part I and part II) are based on the same a priori approved review protocol. The decision to provide two review reports for one review protocol was justified for the sake of improved organization of the results. The volume of information from part I and part II, if combined, would make the review excessively long and difficult to read. Furthermore, some studies analysed the perspectives of both patients/families and healthcare providers. Thus, to minimize the risk of study selection bias, the reviewers decided that a separate round of critical appraisal and data extraction of studies was prudent in order to fully and independently explicate the perspectives of patients/families and healthcare providers.Furthermore, the textual component initially proposed in the approved review protocol was not included namely because the majority of FWR and FWIP protocols from the included studies could not be located for further analysis. Also, the reviewers determined that a separate systematic review that searches specifically for studies rich in textual information would be needed to truly capture the breadth of expert opinions and consensus statements on the issues of FWR and FWIP.