Effectiveness of Family-Focused End of Life and Bereavement Interventions Across Neonatal, Paediatric, and Adult Intensive Care: An Overview of Reviews.

BACKGROUND

Intensive Care Units (ICUs) care for critically ill patients across all age groups, with many deaths occurring during or shortly after admission. For families, this can be associated with significant psychological distress, including prolonged grief, depression, and post-traumatic stress. Family experiences are influenced by the quality of end-of-life communication, involvement in decision-making, and the availability of bereavement support. Despite this, bereavement care across neonatal, paediatric, and adult ICUs remains inconsistent, highlighting the need for evidence-based strategies.

OBJECTIVE

To identify, summarise, and report the effectiveness and impact of end-of-life and bereavement interventions delivered by ICU staff on family psychological, social, and physiological outcomes.

DESIGN

Overview of reviews.

SETTING(S): Neonatal, paediatric, and adult ICUs internationally.

METHODS

A comprehensive search (PROSPERO CRD42024581827) was conducted across Medline, Embase, Scopus, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, and PsycINFO, with an updated search in 2025. Screening was completed by two research team members. Risk of bias was assessed using ROBIS. Data were extracted as reported in each systematic review and analysed narratively.

RESULTS

Fifteen systematic reviews (145 primary studies) were included across neonatal (n = 4), paediatric (n = 1), adult (n = 9), and mixed settings. Interventions were diverse and often multi-component. Communication-focused strategies that were timely, honest, and individualised were associated with improved family satisfaction and perceptions of care. Opportunities for family presence, shared decision-making, and relational nursing support were reported as central to understanding, acceptance, and adjustment. Memory making and bereavement follow-up were valued, though impacts on psychological outcomes varied. Evidence was limited by inconsistent outcome measures and minimal paediatric-specific reviews.

CONCLUSIONS

ICU family-focused end-of-life and bereavement interventions can provide meaningful support, but effectiveness is difficult to determine due to inconsistent implementation and methodological variation. Findings highlight the importance of individualised and relational approaches, and suggest culturally responsive care may influence how interventions are experienced.