Guideline Title
Best evidence statement (BESt). Sibling support in end of life care.
Bibliographic Source(s)
| Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Sibling support in end of life care. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Jun 7. 5 p. [10 references] |
Guideline Status
This is the current release of the guideline.
UMLS Concepts ( what's this?)
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Disease/Condition(s)
- Grief response
- Bereavement
Guideline Category
Management
Clinical Specialty
Family Practice
Pediatrics
Psychiatry
Psychology
Intended Users
Advanced Practice Nurses
Nurses
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Guideline Objective(s)
To evaluate, among siblings of actively dying patients, if sibling involvement and preparation at patient's end of life compared to no involvement and preparation impacts the siblings' grief response
Target Population
Siblings 3-21 years of age of terminally ill children at patient's end of life
Interventions and Practices Considered
Sibling preparation and involvement at patient's end of life
Major Outcomes Considered
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Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Search Strategy
Terms: grief, children, sibling, death
Databases: PubMed, Medline, Google Scholar, CINAHL
No date limits used. Last search: 3/17/11
Number of Source Documents
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Table of Evidence Levels
| Quality Level |
Definition |
| 1a† or 1b† |
Systematic review, meta-analysis, or meta-synthesis of multiple studies |
| 2a or 2b |
Best study design for domain |
| 3a or 3b |
Fair study design for domain |
| 4a or 4b |
Weak study design for domain |
| 5 |
Other: General review, expert opinion, case report, consensus report, or guideline |
†a = good quality study; b = lesser quality study
Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Rating Scheme for the Strength of the Recommendations
Table of Recommendation Strength
| Strength |
Definition |
| "Strongly recommended" |
There is consensus that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations). |
| "Recommended" |
There is consensus that benefits are closely balanced with risks and burdens. |
| No recommendation made |
There is lack of consensus to direct development of a recommendation. |
| Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below. |
- Grade of the Body of Evidence (see note above)
- Safety/Harm
- Health benefit to patient (direct benefit)
- Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
- Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
- Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
- Impact on morbidity/mortality or quality of life
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Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
Reviewed against quality criteria by two independent reviewers
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Major Recommendations
The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a-5b) are defined at the end of the "Major Recommendations" field.
It is recommended that siblings of actively dying children be involved and prepared for their siblings' death to facilitate appropriate grief responses (Lauer et al., 1985 [4a]; Freeman, O'Dell, & Meola, 2003 [4a]; Pettle Michael & Lansdown, 1986 [4b]; Martinson et al., 1990 [4b]; Nolbris & Hellstrom, 2005 [4b]; Bendor, 1989 [5a]; Heiney, 1991 [5a]; Carr-Gregg & White, 1987 [5a]; Duncan, Joselow & Hilden, 2006 [5b]; Giovanola, 2005 [5b]).
Definitions:
Table of Evidence Levels
| Quality Level |
Definition |
| 1a† or 1b† |
Systematic review, meta-analysis, or meta-synthesis of multiple studies |
| 2a or 2b |
Best study design for domain |
| 3a or 3b |
Fair study design for domain |
| 4a or 4b |
Weak study design for domain |
| 5 |
Other: General review, expert opinion, case report, consensus report, or guideline |
†a = good quality study; b = lesser quality study
Table of Recommendation Strength
| Strength |
Definition |
| "Strongly recommended" |
There is consensus that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations). |
| "Recommended" |
There is consensus that benefits are closely balanced with risks and burdens. |
| No recommendation made |
There is lack of consensus to direct development of a recommendation. |
| Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below. |
- Grade of the Body of Evidence (see note above)
- Safety/Harm
- Health benefit to patient (direct benefit)
- Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
- Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
- Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
- Impact on morbidity/mortality or quality of life
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Evidence Supporting the Recommendations
References Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).
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Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Supporting siblings at the time of death of their brother or sister can promote normal growth and development and facilitate healthy adjustment to the loss.
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Qualifying Statements
This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.
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Implementation of the Guideline
Description of Implementation Strategy
An implementation strategy was not provided.
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Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Staying Healthy
IOM Domain
Patient-centeredness
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Identifying Information and Availability
Bibliographic Source(s)
| Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Sibling support in end of life care. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Jun 7. 5 p. [10 references] |
Adaptation
Not applicable: The guideline was not adapted from another source.
Guideline Developer(s)
Cincinnati Children's Hospital Medical Center - Hospital/Medical Center
Source(s) of Funding
Cincinnati Children's Hospital Medical Center
Composition of Group That Authored the Guideline
Group/Team Members: Tina Ulanowski, M.Ed., CCLS, Cincinnati Children's Hospital Medical Center StarShine Hospice and Palliative Care; Susan McGee, MSN, RN, CNP, Division of Developmental and Behavioral Pediatrics; Barbara Giambra, MS, RN, CNP, Evidence-based Practice Mentor, Center for Professional Excellence, Research, and Evidence-based Practice
Financial Disclosures/Conflicts of Interest
Guideline Status
This is the current release of the guideline.
Guideline Availability
Electronic copies: Available from the Cincinnati Children's Hospital Medical Center  .
Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Children's Hospital Medical Center Health Policy and Clinical Effectiveness Department at HPCEInfo@chmcc.org.
Availability of Companion Documents
The following are available:
Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Children's Hospital Medical Center Health Policy and Clinical Effectiveness Department at HPCEInfo@chmcc.org.
NGC Status
This NGC summary was completed by ECRI Institute on November 3, 2011.
Copyright Statement
This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:
Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:
- Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
- Hyperlinks to the CCHMC website may be placed on the organization's website
- The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents; and
- Copies may be provided to patients and the clinicians who manage their care.
Notification of CCHMC at HPCEInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.
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