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

ABSTRACT

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.

Key Points

• What is already known

  • ○
    Communication quality strongly shapes family satisfaction and distress.
  • ○
    Bereavement interventions vary widely and show inconsistent effectiveness.
  • ○
    Paediatric ICU evidence is limited, leaving key gaps in current knowledge.
• What this paper adds

  • ○
    Summarised evidence of interventions evaluated by families across neonatal, paediatric, and adult ICU settings.
  • ○
    Identifies communication, presence, and memory making as consistently valued.
  • ○
    Highlights need for tailored, culturally responsive, family‐directed care models.

1. Background

Intensive Care Units (ICUs) provide critical support for people with severe illnesses or injuries. Although many patients survive their ICU admission, 5.1%–16.2% of adults and 2.1%–9.1% of children die in the ICU, and a further 7.8%–22.4% of adults and approximately 2.7% of children do not survive to hospital discharge (Al‐Eyadhy et al. ²⁰²¹; Australian and New Zealand Intensive Care Society ²⁰²⁵; Botan et al. ²⁰²²; Hannegård Hamrin and Eksborg ²⁰²²; Johnson et al. ²⁰²¹; Paediatric Intensive Care Audit Network (PICANet) ²⁰²⁵; Vincent et al. ²⁰¹⁴). The death of a family member in ICU can result in significant emotional challenges, with 4.8%–21% of bereaved family members experiencing prolonged grief disorder (Kentish‐Barnes et al. ²⁰²²; Wen, Prigerson, Chuang, et al. ²⁰²⁴). Prolonged grief disorder is characterised by persistent and intense separation distress, including persistent yearning and preoccupied thoughts for their loved one, and is associated with an increased risk of comorbid depression and post‐traumatic stress disorder (PTSD) (Killikelly et al. 2025).

The bereavement experience for families is deeply influenced by their interactions with healthcare providers during end‐of‐life care (Kentish‐Barnes et al. ²⁰²²). Therefore, it is crucial that family members are treated as integral components of the care team rather than simply caregivers (Wen, Prigerson, Hu, et al. ²⁰²⁴). Structured approaches to care planning that actively involve family members can lead to more personalised experiences, alleviating distress and enhancing overall satisfaction for families during an already challenging time (Chen et al. 2020; Engel et al. ²⁰²³).

Existing literature highlights a critical need for improved bereavement support across ICUs, particularly within neonatal, paediatric, and adult settings. However, ICU‐based bereavement support services are often limited or ad hoc (Butler et al. 2024; Efstathiou et al. ²⁰¹⁹; Egerod et al. ²⁰¹⁹; McAdam and Erikson ²⁰¹⁶). Effective end‐of‐life care practices must not only cater to the medical needs of critically ill patients but also encompass the emotional, psychological, and social needs of their families, supporting them as they adapt to new roles in the absence of their loved one. To address these needs, it has been proposed that standardised bereavement frameworks be developed, with flexible and individualised implementation that seamlessly integrates end‐of‐life interventions from the onset of ICU admission through the entire bereavement period (Foran et al. 2025).

This overview of reviews systematically aggregates evidence from systematic reviews on the effectiveness of family‐focused end of life and bereavement interventions in neonatal, paediatric, and adult ICU settings, offering insights to inform the development of effective and compassionate care frameworks.

2. Methods

2.1. Objectives

To identify and summarise the effectiveness and impact of end‐of‐life and/or bereavement care interventions delivered from the neonatal, paediatric, or adult ICU on the psychological, social, and physiological outcomes of patients' families, as reported in systematic reviews. An overview of reviews was chosen for its ability to summarise and report the scope of existing evidence from multiple reviews into a single, accessible source (Grant and Booth 2009; Pollock et al. ²⁰²⁴).

2.2. Protocol and Registration

A protocol was developed and preregistered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42024581827) on 21 October 2024, and updated to reflect the use of Cochrane's Overview of Reviews guidance and the ROBIS tool for risk of bias assessment (Pollock et al. 2024). Reporting was conducted in accordance with the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist (Gates et al. 2022; see Supporting Information S1).

2.3. Eligibility Criteria

The eligibility criteria for inclusion are summarised in Table 1. Systematic reviews were eligible if published from 2000 onwards to allow a comprehensive capture of the available evidence and to ensure that earlier reviews, which may have shaped subsequent research, were not excluded. Eligibility criteria were intentionally defined to ensure inclusion of reviews demonstrating key features of systematic methodology. This reflects guidance for overviews of reviews, which recommends the use of predefined criteria to identify systematic reviews, while assessing methodological quality separately (Pollock et al. 2024).

TABLE 1.

Eligibility criteria for inclusion.

Category	Inclusion details
Type of studies	Systematic reviews, with or without meta‐analyses, or qualitative evidence synthesis, as stated in the title or methods section
Minimum criteria	Meeting at least two of the following criteria to demonstrate key features of systematic review methodology: (1) pre‐specified eligibility criteria, such as registration in PROSPERO, (2) use of systematic methods that are explicit and reproducible, such as PRISMA diagram; and (3) assessment of risk of bias or quality
Publication date	Published from 2000 onwards
Population	Families of intensive care patients of any age group who are at the end of life or have died
Setting	Intensive care unit (ICU), including both general and subspecialty ICUs, or a combined ICU/high dependency unit (HDU). Studies with mixed settings were included where ICU‐specific results could be extracted separately
Potential interventions	Received family focused end‐of‐life and/or bereavement interventions provided by the ICU
Outcomes	Extractable results evaluating the effectiveness or impact of interventions on family's psychological, social, or physiological morbidity and/or mortality
Language	English only, as all authors are proficient exclusively in English

Systematic reviews were excluded if they focused solely on ICU patients or healthcare professionals, if interventions were delivered by non‐ICU staff outside of the ICU environment, if no interventions were provided, or if the interventions were unrelated to the ICU admission or experience. Systematic reviews were also excluded if they did not provide an assessment of the effectiveness or impact of the interventions.

2.4. Search Strategy

With the assistance of an academic research librarian (KE), a scoping search of the literature was completed to develop and refine the search strategy. In October 2024, a systematic search was conducted in Medline via Ovid, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) complete, Evidence‐Based Medicine (EBM) reviews—Cochrane Database of Systematic Reviews, Web of Science, and American Psychological Association (APA) PsycINFO. Search terms were adapted to meet the specific formatting and requirements of each database. See Supporting Information S2 for a sample of the data search applied. Reference lists of included articles were checked for additional eligible studies. In October 2025, an updated literature search was conducted to ensure the timeliness of this review.

2.5. Selection of Systematic Reviews

Database search results were imported into Covidence, an online platform that supports the systematic review process (Veritas Health Innovation ²⁰²⁴). Duplicates were removed in Covidence, and titles and abstracts were screened by two independent reviewers (MR, TB, AEB, or KR) based on the predefined inclusion criteria. Full text screening was then conducted by two independent reviewers (MR, TB, AEB, or KR). Discrepancies were resolved through discussions and, when necessary, by involving a third reviewer.

2.6. Data Extraction and Assessment of Methodological Quality

Data were extracted and reported as presented in the included systematic reviews and missing data were not extracted directly from the primary studies, following guidance from the Cochrane Overview of Reviews (Pollock et al. 2024). Author MR conducted the initial data extraction in Covidence and assessed risk of bias using the ROBIS tool (Whiting et al. 2016). Data extracted included systematic review title, authors, country in which the systematic review was conducted, aim, inclusion and exclusion criteria, primary study methodologies, ICU population, number of participants, care interventions and comparators, and outcomes. All extracted data and risk of bias assessment were then independently checked and verified by an independent reviewer (TB, AEB, or KR). Discrepancies were resolved through discussion. See Supporting Information S3 for details of the risk of bias assessed.

2.7. Data Analysis

Extracted data from the included systematic reviews were grouped by topic and summarised to provide a narrative overview of the available evidence. Outcomes are reported using language utilised in the primary systematic reviews (e.g., “reduced anxiety” or “improved satisfaction”). The Graphical Representation of Overlap for OVErviews (GROOVE) tool was used to calculate the corrected covered area (Perez‐Bracchiglione et al. ²⁰²²).

3. Results

Fifteen systematic reviews were included in this review as detailed in the PRISMA flow diagram (see Figure 1). Risk of bias in the systematic reviews was assessed as low (n = 10), high (n = 2), and unclear (n = 3) (see Supporting Information S2). No systematic reviews were excluded based on quality. The ICU settings represented in the systematic reviews included neonatal intensive care units (n = 4) (Brelsford et al. 2024; Lakhani et al. ²⁰²⁴; MacEachen et al. ²⁰²⁴; Mohammadi et al. ²⁰²⁵), a paediatric ICU (n = 1) (Butler et al. 2015), adult ICUs (n = 9) (Coventry et al. 2020; DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Efstathiou et al. ²⁰¹⁹; Galazzi et al. ²⁰²²; Hinkle et al. ²⁰¹⁵; MacEachen et al. ²⁰²⁴; Moss et al. ²⁰²¹; Naya et al. ²⁰²⁴; Rait et al. ²⁰²¹), and two reviews that did not explicitly report their ICU setting (Bjelland and Jones 2022; Brekelmans et al. ²⁰²²). See Table 2 for details of each systematic review included.

FIGURE 1.

PRISMA flow diagram detailing the review selection process. [Colour figure can be viewed at wileyonlinelibrary.com]

TABLE 2.

Summary of interventions identified in systematic reviews.

Author/s, year, country	Study aim	Number of primary studies and ICU setting	Interventions reported	ROBIS: Overall risk of bias in the review
Bjelland and Jones (2022) United States of America	Primary: To identify factors that relieve or contribute to distress for deceased organ donor families following the decision to donate Secondary: To gain insights into strategies to address these deficiencies	17; Not explicitly stated	Information sharing ○ Communication, including family support and agreement with decision Making meaning ○ Organ donation ○ Allowing the family to see their relative after organ procurement Memory making Bereavement support and care interventions ○ Postmortem support and parting ceremonies ○ Commemoration events	Low
Brekelmans et al. (2022) the Netherlands	To give an overview of different bereavement support strategies and possible different effects on anxiety, depression, Post‐traumatic Stress Disorder (PTSD), and complicated grief To assess if there is a difference in organisation among bereavement support strategies mentioned in literature	7; Not explicitly stated; inclusion criteria included “relatives of deceased ICU patients”	Information sharing ○ End‐of‐life conference and brochure Supporting families to participate in or witness care and procedures ○ Witness CPR resuscitation Bereavement support and care interventions ○ Bereavement program containing: (1) bereavement brochure, (2) condolence card and practical tasks resource packet; (3) follow‐up telephone call, (4) note of condolence at 1 year, (5) card sent on former patient's birthday	Low
Brelsford et al. (2024) United States of America	To explore: (1) the availability of psychospiritual supports or interventions for parents/caregivers while in the NICU or upon discharge; (2) if located, explore the components of these psychospiritual supports, with a focus on the religious/spiritual, and psychosocial aspects of these interventions; (3) explore the psychological/emotional well‐being of parents as a result of these interventions	1; NICU	Bereavement support and care interventions ○ Home video discussing grief	Unclear
Butler et al. (2015) Australia	To review, critically appraise, and synthesise the best available evidence exploring experiences of the death of a child in the PICU, from the perspective of the child's family	5; PICU	Supporting families to participate in or witness care and procedures ○ Being a Parent in PICU Bereavement support and care interventions ○ Ongoing contact from staff post‐ICU	Low
Coventry et al. (2020) Australia	To synthesise qualitative studies on the experiences and perceptions of families of adult ICU patients, on the adequacy of EOLC following the withdrawal of life support	13; AICU	Bereavement support and care interventions Information sharing ○ End‐of‐life communication ○ Preparing the family for expectations during treatment withdrawal and dying process	Low
DeSanto‐Madeya and Safizadeh (2017) United States of America	To explore the extent and scope of empirical literature related to family satisfaction with end‐of‐life care in the ICU, discover common themes emerging from studies of family satisfaction with end‐of‐life care in the ICU, and identify areas for further research that may enhance family satisfaction with end‐of‐life care in the ICU	29; AICU	Information sharing ○ Family communication ○ Involvement in the decision‐making process Supporting family presence ○ ICU environment External consultations ○ Spiritual care	High
Efstathiou et al. (2019) United Kingdom	To identify and systematically review primary research related to ICU bereavement support	9; AICU	Meaning making ○ Storytelling Memory making ○ ICU diary ○ Personal memento Bereavement support and care interventions ○ Bereavement follow‐up program ○ Condolence letter ○ Post‐death meeting ○ Research participation	Low
Galazzi et al. (2022) Italy	To investigate the connection between ICU diaries and the grieving process faced by family members of ICU adult deceased patients	6; AICU	Memory making ○ ICU diary ○ Photographs in ICU diary	Low
Hinkle et al. (2015) United States of America	To perform a review, synthesising published data identifying factors associated with family satisfaction with end‐of‐life care in critically ill adult populations	20; AICU	Shared decision making ○ Withdrawal of Life‐Prolonging Therapies Bereavement support and care interventions ○ Nurse liaison program to assist the families of ICU non‐survivors Supporting family presence ○ Family presence at time of death External consultations ○ Palliative care consultation ○ Spiritual care	Unclear
Lakhani et al. (2024) Canada	To synthesise the findings of empirical NICU studies relating to parental bereavement and elaborate on considerations that healthcare practitioners can use to guide their caregiving practices and bereavement support	42; NICU	Shared decision‐making Information sharing Supporting families to participate in or witness care and procedures Making meaning ○ Breastmilk production after loss Memory making External consultations ○ Palliative care and bereavement services ○ Spiritual/religious support Bereavement support and care interventions ○ Bereavement follow‐up ○ Individualising bereavement care	Low
MacEachen et al. (2024) Scotland	To explore families' experiences of memory making practices in critical care, with a view to gaining greater understanding of the ways in which memory making impacts bereaved families and individuals, and the factors which affect their experience of memory making	7; All ages	Memory making	Low
Mohammadi et al. (2025) Iran	To evaluate its impact on symptom management and clinical outcomes in neonates admitted to the NICU, as well as its influence on their parents and the nursing staff	3 NICU	External consultations ○ Palliative care	Unclear
Moss et al. (2021) Canada	To map bereavement interventions to established core outcomes for evaluating bereavement support among informal caregivers, and to identify grief support interventions that improve informal caregivers' ability to cope with the grief	3 AICU	Supporting families to participate in or witness care and procedures Making meaning	Low
Naya et al. (2024) Japan	To provide a quantitative synthesis of the evidence regarding the quality of deaths in the ICU and to offer a comprehensive overview of the factors influencing this quality, including its relationship with PICS‐F	9 AICU	Shared decision making Information sharing Supporting family presence ○ ICU environment and conditions	High
Rait et al. (2021) Australia	To determine the effectiveness of bereavement interventions in reducing persisting psychological distress in bereaved family members after death in an adult ICU	5 AICU	Making meaning ○ Storytelling and personal reflections Memory making Bereavement support and care interventions ○ Bereavement support materials ○ Written expressions of condolence post death ○ Card sent on former patient's birthday ○ Follow‐up call including psychological support	Low

3.1. Overlap of Primary Studies in the Systematic Reviews

The 15 systematic reviews included data from 145 primary studies. There was a slight overlap of primary studies across the 15 included systematic reviews, with the corrected covered area (adjusted for chronological structural missingness) calculated at 1.65%. Specifically, 21 primary studies appeared in two systematic reviews, 3 appeared in three systematic reviews, and 1 appeared in four systematic reviews. All eligible systematic reviews were included regardless of primary study overlap; however, care was taken to avoid double‐counting outcome data. Figure 2 presents the graphical representation of overlap using the GROOVE tool (Perez‐Bracchiglione et al. ²⁰²²). See Supporting Information S4 for listing of the primary studies included in the 15 systematic reviews and the quality assessments for each primary study as reported in the systematic reviews.

FIGURE 2.

Graphical representation of primary study overlap within the included systematic reviews, displayed using the GROOVE tool (Perez‐Bracchiglione et al. ²⁰²²). [Colour figure can be viewed at wileyonlinelibrary.com]

A summary of the included systematic reviews identified the following categories of ICU end‐of‐life and bereavement care interventions and evaluations: shared decision making, information sharing, supporting families to participate in or witness care and procedures, supporting family presence, meaning making, memory making, external consultations such as palliative care, and bereavement support interventions.

3.2. Shared Decision Making

Six systematic reviews reported interventions related to shared decision making, including family inclusion in medical discussions (Bjelland and Jones 2022; Coventry et al. ²⁰²⁰; DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Hinkle et al. ²⁰¹⁵; Lakhani et al. ²⁰²⁴; Naya et al. ²⁰²⁴). When families feel a sense of control over the ICU admission, including being presented with a range of care options, understanding those options, and feeling empowered to make informed decisions, they report perceptions of care as more family‐centred and perceived a higher quality of dying (Coventry et al. 2020; Naya et al. ²⁰²⁴). Support that enhances families' sense of control has been associated with reduced anxiety and may also contribute to lower levels of post‐traumatic stress disorder and prolonged grief (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). In the neonatal literature, involving families in shared decision making was reported to integrate healthcare professional's medical expertise with family's beliefs and values, which may help lessen parents' grief (Lakhani et al. 2024). Variation in families' preferred levels of participation in shared decision making was also reported, with potential negative psychological effects described when actual involvement did not align with those preferences (DeSanto‐Madeya and Safizadeh ²⁰¹⁷).

Empathic, supportive engagement by medical officers during decision‐making has been associated with higher family satisfaction with end‐of‐life care (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). Additionally, involving families in discussions about organ donation helped them feel empowered as active participants in care decisions, regardless of whether they chose to proceed with donation (Bjelland and Jones 2022). One systematic review reported that including families in ICU medical rounds or family meetings improved family satisfaction with end‐of‐life care communication; although from the review, it was not possible to determine which specific intervention, attendance at medical rounds or family meetings, was most influential (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). In contrast, another systematic review reported that family involvement and attendance during ICU medical rounds did not improve family satisfaction with end‐of‐life care in the ICU (Hinkle et al. 2015).

The provision and support of family choice regarding the timing of withdrawing life‐prolonging interventions have been reported in two systematic reviews (Hinkle et al. 2015; Lakhani et al. ²⁰²⁴). For patients admitted to the ICU for longer than eight days, healthcare professionals providing extended periods of withdrawing life prolonging interventions were reported to increase family satisfaction in EOLC. In contrast, shorter ICU stays were associated with increased family satisfaction with EOLC when withdrawal of life prolonging interventions occurred more promptly (Hinkle et al. 2015).

3.3. Information Sharing

Six systematic reviews reported interventions of information sharing practices during end‐of‐life care, where the timing of information delivery, the person providing it, and the content communicated influenced families' perceptions and experiences (Bjelland and Jones 2022; Coventry et al. ²⁰²⁰; DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Hinkle et al. ²⁰¹⁵; Lakhani et al. ²⁰²⁴; Naya et al. ²⁰²⁴).

3.3.1. Timing of Intervention

Providing information that is regular and timely was reported as highly important aspects of positively perceived EOLC in several systematic reviews. Increased communication was reported to help families' facilitate a sense of control in the ICU, reduce anxiety, and potentially lessen heightened psychological experiences such as posttraumatic stress disorder and prolonged grief (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). Families generally did not report feeling that they had too many conversations about their loved one's medical condition (Bjelland and Jones 2022), and conference length was not reported to be associated with family satisfaction of EOLC (Hinkle et al. 2015). In contrast, poor sharing of information contributed to family members experiencing anxiety, stress, anger, and depression, and hindered their ability to prepared for participation in decision making (Coventry et al. 2020; DeSanto‐Madeya and Safizadeh ²⁰¹⁷). When communication was perceived as occurring too late, it was associated with negative lasting memories of the dying process, potentially provoking distress, anger, and anxiety (Coventry et al. 2020). Additionally, a lack of information shared about EOLC was reported to increase families' stress, anxiety and depression during the ICU stay, with these psychological experiences possibly persisting into their bereavement (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). No systematic review provided definitions of what ‘regular’ or ‘too late’ meant in clinical practice.

3.3.2. Person Delivering Information

Family members often perceive nurses as primary sources of information (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). When medical officers initiate conversations about withdrawing life‐prolonging interventions, family satisfaction with end‐of‐life care increases (Hinkle et al. 2015). However, if discussions about the possibility of transitioning to end‐of‐life care occur before families feel prepared, they may experience dissatisfaction with EOLC and a loss of trust in the healthcare professionals (DeSanto‐Madeya and Safizadeh ²⁰¹⁷).

The opportunity to build a trusting relationship with a specific nurse or medical officer from admission through to bereavement was reported to increase the family's sense of trust during the ICU admission (Coventry et al. 2020). In neonatal settings, providing continuity of care and the development of relationships were also reported as beneficial (Lakhani et al. 2024). However, the definition of “beneficial” was not provided.

3.3.3. Content of Information

Across all ICU settings, communication content and tone that was clear, truthful, honest, and sensitive to the situation were reported as factors that may positively influence family satisfaction with the EOLC provided (Coventry et al. 2020; DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Lakhani et al. ²⁰²⁴). In the neonatal literature, the use of language that presumes understanding, such as “I know how you feel,” can cause distress (Lakhani et al. 2024). Additionally, clear explanations of the withdraw process was associated with increased family satisfaction in EOLC (Hinkle et al. 2015). Clarity and structure of communication improved when images or diagrams were used with frank descriptions of what families might see or hear during the dying process, helping to minimise future painful recollections caused by the unpredictable nature of dying (Bjelland and Jones 2022; Coventry et al. ²⁰²⁰). Assurances from healthcare professionals regarding patient comfort, particularly through effective pain and symptom management, were reported as important components of care interventions and were factors associated with higher perceived quality of dying (Coventry et al. 2020; Lakhani et al. ²⁰²⁴; Naya et al. ²⁰²⁴). Additionally, parents' perceptions of their infant suffering were influenced by information provided by healthcare professionals (Lakhani et al. 2024), although, specifics of the information provided by the healthcare professionals was not provided in the systematic review.

Facilitating opportunity for families to speak during conferences, along with healthcare professionals' expressions of empathy, and reassurance of non‐abandonment, were associated with increased family satisfaction in EOLC (DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Hinkle et al. ²⁰¹⁵). Additionally, families who received tailored written information to help them prepare for the dying process following withdrawal of life‐prolonging interventions reported greater satisfaction with the information provided and felt better informed about what to expect (Hinkle et al. 2015).

Conversely, the use of medical jargon, inadequate explanations of the patient's condition, such as understanding of brain death, and failure to assess the family's understanding of the situation or appreciate their potential difficulty processing information during periods of heightened stress were associated with poor information sharing. These factors increased the risk of complicated grief, reduced family satisfaction with EOLC, and potentially contributed to uninformed or misguided decision making by the family (Bjelland and Jones 2022; DeSanto‐Madeya and Safizadeh ²⁰¹⁷).

3.4. Supporting Families to Participate in or Witness Care and Procedures

Five systematic reviews reported providing support for families to participate in or witness care and procedures, such as removal of invasive lines, parenting their child, brain death testing, and cardiopulmonary resuscitation (CPR), which influenced their experiences during end‐of‐life care and into their bereavement (Bjelland and Jones 2022; Brekelmans et al. ²⁰²²; Butler et al. ²⁰¹⁵; Lakhani et al. ²⁰²⁴; Moss et al. ²⁰²¹).

In the neonatal context, supporting families to better focus on their child can be achieved by removing monitoring and medical devices (Lakhani et al. 2024). In both the neonatal and paediatric literature, allowing parents to fulfil parenting roles for their infant or child throughout the end‐of‐life period has been reported as important, and may help ease some of what is lost following the death (Butler et al. 2015; Lakhani et al. ²⁰²⁴). However, not all parents are comfortable with every option offered and may feel pressured if nurses imply that declining might result in future regret (Lakhani et al. 2024).

In the context of brain death, two systematic reviews reported on supporting family members to observe brain death testing and ask questions to the support person during the process (Bjelland and Jones 2022; Moss et al. ²⁰²¹). While one systematic review reported the intervention had no significant improvement in the families' emotional or psychological distress or their ability to resume work or social activities at 3‐months (Moss et al. 2021), the other reported that family understanding significantly improved when they were supported to attend the brain death examination or view diagnostic imaging (Bjelland and Jones 2022). This increased understanding of brain death is associated with a more positive hospital experience, which is linked to reduced grief and enhanced personal growth, and may also mitigate guilt arising from misunderstandings about brain death, particularly if families perceive that withdrawal of life‐prolonging interventions contributed to the patient's death. Family members who do not understand brain death are significantly more likely to develop symptoms of complicated grief (Bjelland and Jones 2022).

As a form of bereavement support, one systematic review reported that families who received information and healthcare professional support for the opportunity to witness cardiopulmonary resuscitation experienced fewer symptoms of depression, post‐traumatic stress disorder (PTSD), and complicated grief (Brekelmans et al. 2022).

3.5. Supporting Family Presence

Six systematic reviews described interventions to support family presence at the bedside (Bjelland and Jones 2022; Butler et al. ²⁰¹⁵; Coventry et al. ²⁰²⁰; DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Hinkle et al. ²⁰¹⁵; Lakhani et al. ²⁰²⁴). Results from both paediatric and adult settings indicate that supporting the presence of family and friends to care for the patient and each other, along with the opportunity to maintain an unrestricted bedside vigil, can help reduce anxiety, provide opportunities to foster positive memories through reminiscence, and improve their acceptance and closure (Butler et al. 2015; Coventry et al. ²⁰²⁰). Nurses' efforts to help families create positive memories of the dying person were also reported to influence the family's perception of a peaceful death (Coventry et al. 2020). Families who were offered the opportunity to personalise the environment, such as bringing in personal items or playing music, reported that these rituals helped create a more intimate and memorable experience (Bjelland and Jones 2022).

Environmental factors such as noise level, lighting, room size, and cleanliness in ICU waiting areas also influenced family satisfaction with end‐of‐life care (DeSanto‐Madeya and Safizadeh ²⁰¹⁷). In the adult ICU literature, facilitating family presence at the time of death has been associated with an increase in the quality of dying and death (QODD) scores (Hinkle et al. 2015). Additionally, nurses creating a change in the environment, such as dimming the lighting after brain death, may support families' processing of the situation when accompanied by clear explanations confirming that death has occurred (Bjelland and Jones 2022). In the neonatal literature, it has been reported that while some parents find holding their infant deeply meaningful, others may choose not to be present at the moment of death. These parents may still find comfort in speaking to their baby beforehand, holding them while still warm, or entrusting their care to a friend or healthcare professional (Lakhani et al. 2024). After death, families reported feelings of abandonment and heightened distress when they were not provided, in their view, sufficient time and privacy at the bedside (Coventry et al. 2020).

3.6. Making Meaning

Five systematic reviews reported care interventions to support families in assigning meaning to the loss of a loved one, including offering the opportunity to participate in organ donation decisions, supporting mothers with lactation and subsequent milk donations during bereavement, and the process of storytelling (Bjelland and Jones 2022; Efstathiou et al. ²⁰¹⁹; Lakhani et al. ²⁰²⁴; Moss et al. ²⁰²¹; Rait et al. ²⁰²¹).

3.6.1. Organ Donation

For some families, healthcare professionals providing the opportunity to proceed with organ donation helped balance their feelings of despair with a sense of hope and pride (Bjelland and Jones 2022). However, some families who consented to organ donation later reported feelings of guilt, and others in one context experienced accusations of body fragmentation or organ selling, which intensified their grief (Bjelland and Jones 2022). Families given the opportunity to see their loved one after organ donation surgery often described this as a positive experience despite the mixed emotions of closure and grief (Bjelland and Jones 2022).

3.6.2. Milk Donations

Following neonatal death in the ICU, many mothers experience heightened emotions, including sadness, emptiness, and anxiety when pumping milk. However, for others, the opportunity and support to donate milk has been reported as a meaningful outlet for their grief and can offer a sense of purpose (Lakhani et al. 2024). Milk donations may facilitate acceptance and healing by sustaining the child's legacy, helping other infants in need, and providing comfort through the belief that their child's life continues to have an impact beyond death (Lakhani et al. 2024).

3.6.3. Family Member's Storytelling

Three systematic reviews reported an intervention in which family members engaged in personal reflections, such as storytelling (Efstathiou et al. 2019; Moss et al. ²⁰²¹; Rait et al. ²⁰²¹). Reflective storytelling was described as a post‐ICU intervention that facilitated family's reflection of the time surrounding the ICU admission (Moss et al. 2021). Overall, family members who participated in storytelling reported feeling “better”’ or “much better” at 6‐months, and none reported feeling “much worse” (Efstathiou et al. 2019). However, the intervention did not having a significant effect on participants' experience of complicated grief, anxiety, depression, or post‐traumatic stress at 3 and 6‐months follow‐up (Moss et al. 2021; Rait et al. ²⁰²¹).

3.7. Memory Making

Memory making practices, including hand/foot prints or moulds, clothing, identification bands, blankets, as well as ICU diaries, have been reported in systematic reviews across all ICU settings (Brekelmans et al. 2022; Efstathiou et al. ²⁰¹⁹; Galazzi et al. ²⁰²²; Lakhani et al. ²⁰²⁴; MacEachen et al. ²⁰²⁴; Rait et al. ²⁰²¹). Photographs, provided independently of the ICU diaries, have also been reported as memory making objects (Lakhani et al. 2024; MacEachen et al. ²⁰²⁴). Memory making objects have been reported to be highly valued by many families, including reports from families that they were extremely or very helpful to their coping with the death, as they provided comfort during bereavement and helped maintain bonds to the deceased (Efstathiou et al. 2019; Lakhani et al. ²⁰²⁴; MacEachen et al. ²⁰²⁴).

Memory making activities are frequently facilitated by nursing staff, who suggested, guided, and supported families in creating the objects. Failure to respect family preferences regarding the objects can contribute to emotional harm, including instances where photographs were taken contrary to cultural beliefs or when ‘poor quality’ photographs were deleted without permission (MacEachen et al. ²⁰²⁴). These objects contributed to reducing concerns about their loved one's memory or likeness fading over time and supported ongoing connection, and served as tools for sharing experiences and memories with others (Lakhani et al. 2024; MacEachen et al. ²⁰²⁴).

3.7.1. ICU Diaries Including Photographs

Facilitating ICU diaries during the ICU admission and providing them to families after the patient's death has been reported as an intervention, with some including photographs as part of the content. However, the authors of the ICU diary entries were not specified in the systematic reviews (Brekelmans et al. 2022; Efstathiou et al. ²⁰¹⁹; Galazzi et al. ²⁰²²; Rait et al. ²⁰²¹). Overall, ICU diaries have been reported positively by the families, helping them connect the present with the past and supporting remembrance, understanding, and acceptance of the ICU experience (Efstathiou et al. 2019; Galazzi et al. ²⁰²²). Photographs included in the ICU diaries contributed to families' understanding, although some families experienced emotional distress from seeing them (Galazzi et al. 2022). However, it is also reported that ICU diaries sent to families with an accompanying letter by ICU healthcare professionals were not associated with lower family anxiety, depression, or PTSD (Brekelmans et al. 2022). Additionally, one systematic review reported a care bundle intervention that included ICU diaries, communication training, and private rooms for families, which reported neutral effects on the Impact of Event Scale; however, the specific influence of the ICU diary was not reported (Rait et al. 2021).

3.8. External Consultations, Including Palliative Care, Spiritual Care, Mental Health Support

Five systematic reviews reported information on facilitating consultations external to the ICU, such as palliative care and spiritual care (Bjelland and Jones 2022; DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Hinkle et al. ²⁰¹⁵; Lakhani et al. ²⁰²⁴; Mohammadi et al. ²⁰²⁵). Early integration of palliative care in the NICU has been reported to significantly reduce maternal anxiety, enhance the mother's positive cognitive reframing, and improve communication and family relationships, which were reported to contribute to an improved quality of life for the family (Mohammadi et al. 2025). However, it was not reported if the benefits arise specifically from palliative care involvement or from increased utilisation of end of life and bereavement interventions, as palliative care engagement has also been associated with increased engagement in memory making activities, offering baptism or other rituals, facilitating family presence and participation in the caregiving (Mohammadi et al. 2025), and greater family meetings (Lakhani et al. 2024).

Some families in both neonatal and adult settings have reported benefits from the provision of spiritual care services, such as prayers, rituals, and time spent with clergy reflecting on the life of the patient (DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Lakhani et al. ²⁰²⁴). Providing interventions, such as discussions and external consultations to address spiritual needs, particularly during the final 24 h of life, has been associated with higher satisfaction with spiritual care, increased family satisfaction with decision making, improved satisfaction with end‐of‐life care, and may help reduce negative psychological impacts (DeSanto‐Madeya and Safizadeh ²⁰¹⁷; Hinkle et al. ²⁰¹⁵).

3.9. Bereavement Support and Care Interventions

Ten systematic reviews reported care intervention outcomes related to bereavement supports provided, including a dedicated nurse liaison, written material such as a bereavement brochure, follow‐up meetings, letters or cards, informational videos, and the ability to participate in research (Bjelland and Jones 2022; Brekelmans et al. ²⁰²²; Brelsford et al. ²⁰²⁴; Butler et al. ²⁰¹⁵; Coventry et al. ²⁰²⁰; Efstathiou et al. ²⁰¹⁹; Hinkle et al. ²⁰¹⁵; Lakhani et al. ²⁰²⁴; Moss et al. ²⁰²¹; Rait et al. ²⁰²¹).

3.9.1. Nurse Liaison

One systematic review reported designated roles to assist bereaved families, such as a nurse liaison, which can facilitate increased family satisfaction with EOLC. However, it was critiqued that the evaluation tool was unvalidated and there was a lack of control group for comparison (Hinkle et al. 2015).

3.9.2. Post‐ICU Correspondence

Four systematic reviews reported interventions related to providing written information, such as bereavement brochures or post‐ICU admission summaries, to bereaved ICU families (Brekelmans et al. 2022; Efstathiou et al. ²⁰¹⁹; Lakhani et al. ²⁰²⁴; Rait et al. ²⁰²¹). In the neonatal literature, receiving a post‐ICU admission summary in layman's terms and including the baby's name (if available) is reported by families as beneficial (Lakhani et al. 2024). Two systematic reviews reported bereavement brochures as a component of larger care bundles. However, the independent utility of bereavement brochures was not provided in the systematic reviews, and the care bundle components largely varied, restricting the ability to draw potential conclusions (Brekelmans et al. 2022; Rait et al. ²⁰²¹). Though, another systematic review reported that less than half of families who received a brochure as part of a larger bereavement follow‐up program read it and found it helpful (Efstathiou et al. 2019).

Follow‐up contact from the ICU was reported to be appreciated and highly valued by families from all ICU settings. The follow‐up might consist of meetings, phone calls, letters, cards, or funeral attendance (Butler et al. 2015; Efstathiou et al. ²⁰¹⁹; Lakhani et al. ²⁰²⁴; Moss et al. ²⁰²¹). No systematic reviews reported inviting families to attend an ICU‐specific memorial service. In the neonatal literature, most parents attended follow‐up meetings with the ICU team when offered, and parents value healthcare professionals' efforts to assess their coping, the provision of honest and sensitively delivered information, and offering reassurance when appropriate (Lakhani et al. 2024).

One systematic review reporting broader follow‐up programs for families involved in organ donation reported that follow‐up meetings, tributes for the donor's relatives, and thank‐you letters from the hospital enabled reconciliation for the families (Bjelland and Jones 2022). However, the specific impact of the follow‐up meeting versus other care bundle components was not reported. In the adult ICUs, most families who attended a follow‐up meeting were reported to be very satisfied or satisfied and appreciated the presence of both the medical officer and nurse. Even among families who were not satisfied with the meeting, a large majority were still reported to believe that follow‐up meetings should be offered (Efstathiou et al. 2019). Alternatives to in‐person meetings, such as telephone calls, were also reported as helpful by most family participants (Efstathiou et al. 2019).

Four systematic reviews reported results regarding the intervention of families receiving a handwritten condolence letter in early bereavement. While a portion of families reported being surprised to receive the letter, receiving the letter had no reported effect on the family member's anxiety or depression at one month compared to those who did not receive the letter. Additionally, recipients of the letter had a statistically significant increase in the hospital anxiety and depression score (HADS) at 6‐months (Brekelmans et al. 2022; Efstathiou et al. ²⁰¹⁹; Moss et al. ²⁰²¹; Rait et al. ²⁰²¹). There were no reported complaints from families who received the letter, and many families wished to thank the ICU clinician for the letter. The letter was reported to potentially help some family feel supported rather than specifically reduce their grief symptoms (Efstathiou et al. 2019).

Alternatively, two systematic reviews reported a handwritten condolence note sent one year after the patient's death, as a component of a broader care bundle that also included bereavement brochures, condolence cards and resource packets at one week, two follow‐up phone calls, and a card on the patient's birthday (Brekelmans et al. 2022; Rait et al. ²⁰²¹). The specific impact of the handwritten condolence note was not reported. However, families who received the full bereavement intervention had a significantly lower risk of experiencing prolonged grief compared to those who did not receive the support. However, there was no reported impact on anxiety, depression or PTSD (Brekelmans et al. 2022; Rait et al. ²⁰²¹). Other forms of written follow‐up, such as sympathy cards, have also been reported as meaningful to families (Efstathiou et al. 2019). Additionally, families involved in organ donation have also expressed a desire to receive letters from organ recipients, as a way to contribute to meaning making with the death (Bjelland and Jones 2022).

3.9.3. Informational Videos

One systematic review reported a bereavement care intervention in which NICU parents watched a home video discussing grief (Brelsford et al. 2024). Reported engagement with the video intervention was low, and no significant differences were identified between the intervention and standard bereavement care group in depression, grief, social support, or spiritual/religious beliefs at 3 or 12 months. However, logistic regression indicated that parents who watched the video experienced higher levels of grief at 3 months compared to those who did not (Brelsford et al. 2024).

3.9.4. Research Participation

One systematic review reported that providing families with the opportunity to participate in research to be a potentially beneficial form of bereavement support by allowing families an opportunity to express gratitude to the healthcare team, help other bereaved families, and potentially find meaning in the death (Efstathiou et al. 2019).

4. Discussion

This overview of reviews summarised evidence from 15 systematic reviews encompassing 145 primary studies that reported the impacts of end‐of‐life and bereavement care interventions on family psychological, physiological, or social outcomes following the death of a loved one in an intensive care unit. Although the search timeframe extended from 2000 onwards, the oldest included reviews were published in 2015, indicating that the evidence base in this area is relatively recent. Across neonatal, paediatric, and adult ICU settings, several key categories of end‐of‐life and bereavement‐related care interventions were identified, including communication‐focused strategies, family involvement and memory making, emotional support, and bereavement‐specific follow‐up interventions, reflecting a continuum of care that begins during critical illness and extends after ICU. See Figure 3 for end‐of‐life and bereavement care interventions corresponding to ICU care trajectory. Despite this wide range of diverse interventions, the overall impact for each intervention on family outcomes remains unclear due to substantial heterogeneity in intervention designs, timing, delivery, and outcome measurement. This variation limits not only interpretation of effectiveness, but also the ability to assess the relative strength or comparative impact of different intervention categories across ICU settings. These findings suggest that the selection of appropriate end‐of‐life and bereavement care interventions requires close attention to the unique needs and goals of each family from the range of available approaches.

FIGURE 3.

End‐of‐life and bereavement care interventions corresponding to ICU care trajectory. [Colour figure can be viewed at wileyonlinelibrary.com]

Notably, although this overview of reviews included evidence from all ICU populations, very little review‐level evidence was identified for paediatric ICUs. This limits the extent to which findings can be confidently drawn beyond neonatal and adult settings and highlights an important gap in the current evidence base. Given the distinct developmental, relational, and decision‐making contexts of paediatric ICU end‐of‐life care, the lack of robust paediatric ICU synthesis of primary research is particularly concerning, and targeted primary studies and systematic reviews in this population are urgently needed.

Across the included systematic reviews, communication‐focused interventions emerged as a central and recurring component of end‐of‐life and bereavement care, featuring in six systematic reviews. Timely, honest, and sensitive communication delivered by trusted clinicians was often associated with improved family satisfaction, a higher perceived quality of dying, improved perceptions of support, and in some cases, better psychological outcomes. Conversely, when communication interventions were poorly timed, unclear, or misaligned with family needs and preferences, it was associated with dissatisfaction, heightened distress, and lasting negative psychological consequences. While the importance of open, honest, and compassionate communication at the end of life is well established (Anderson et al. 2019; Brooks et al. ²⁰¹⁷; Chen et al. ²⁰²⁰; Olsson et al. ²⁰²¹; Schram et al. ²⁰¹⁷), our findings reinforce the significance of therapeutic, tailored communication as a modifiable determinant of family experience of end‐of‐life care across neonatal, paediatric, and adult intensive care settings with implications not only for immediate ICU experience but also for longer‐term bereavement outcomes, potentially influencing the development of heightened psychological responses (Kentish‐Barnes et al. ²⁰²²; Lautrette et al. ²⁰⁰⁷). Evidence from integrative reviews further suggests that practices such as family ward rounds can meaningfully enhance families' involvement, autonomy, and preparedness, further reinforcing the value of relational and participatory care models in ICU (Kydonaki et al. 2021).

Family presence at the bedside, particularly within a de‐medicalised end of life environment, was also identified as a key contributor to comfort, dignity, and opportunities for memory making. Families across ICU settings valued care practices that reduced unnecessary monitoring, removed invasive devices, and enabled personalisation of the environment, which may support acceptance and adjustment during bereavement. In contrast, the continued presence of medical devices at the time of death has been associated with lower family satisfaction and poorer perceived quality of dying (Hinkle et al. 2015). Although a recent intervention study reported that implementing formal end‐of‐life care guidelines can support de‐medicalisation and reduce physiological observations, improvements in family‐reported satisfaction with EOLC were modest (Lovell et al. 2025). This suggests that environmental and procedural changes, while necessary, are likely insufficient in isolation and must be complemented by relational and interpersonal aspects of care. These findings support the use of a suite of interventions that combine structural and relational elements and are flexibly tailored to individual family needs.

Cultural and contextual factors likely shape how families experience end‐of‐life and bereavement care interventions, although these were not explicitly reported in all included systematic reviews. Some ICU nurses have reported feeling discomfort when caring for culturally diverse families, particularly when expectations and rituals around death are unfamiliar, perceived as unconventional, or not well understood (O'Neill et al. ²⁰²⁵). This may influence whether interventions such as organ donation, memory making, family presence, or spiritual support are offered, as well as how they are experienced by families. Greater attention to these factors in future research would help support more individualised and culturally responsive approaches to end‐of‐life and bereavement care interventions.

Families value care delivery that preserves personhood and dignity, including the use of the patient's name, attentiveness to family cues, and provision of physical and emotional comfort (Butler et al. 2015; Coventry et al. ²⁰²⁰). Nurses play a central role in facilitating family presence, relational care, and continuity at the end of life. Their sustained bedside presence can enable trust‐building, advocacy, and ongoing communication (Coventry et al. 2020; Lakhani et al. ²⁰²⁴), even when they are not commonly involved in initiating end of life decisions or discussions (Benbenishty et al. 2024). Nurses also play a key role in memory making practices, involving the creation of tangible objects or keepsakes such as locks of hair. Our findings show these practices were valued by some families as a means of supporting continued bonds and acceptance after death, aligning with contemporary bereavement theory that emphasises oscillation between loss‐orientation and restoration‐orientated coping (Stroebe and Schut 1999). However, evidence indicates that the utility of memory making is variable and often influenced by healthcare professionals' confidence, education, and perceived skill (Riegel et al. 2022). Importantly, memory making should be offered rather than assumed and carefully individualised to family readiness, preferences, and cultural values, as not all families engage with or utilise these objects during bereavement (MacEachen et al. ²⁰²⁴; Riegel et al. ²⁰²³).

Structural and workforce factors further shape the delivery of end‐of‐life and bereavement care. Higher nurse‐to‐patient ratios and continuity of nursing care are associated with more positive family perceptions of end‐of‐life care (DeSanto‐Madeya and Safizadeh ²⁰¹⁷), whereas time constraints, staffing pressures, and unsupportive team cultures can inhibit the provision of interventions such as memory making (Riegel et al. 2022). These findings underscore the importance of nursing‐led, culturally sensitive approaches that balance proactive support with respect for family autonomy, reinforcing the role of nurses as key facilitators of dignified dying and healthy bereavement trajectories.

Many interventions identified in this overview of reviews were initiated while the patient was still alive in the ICU, reflecting continuity between end‐of‐life care and bereavement support. Some interventions, such as memory‐making activities, provided tangible objects that families carried into the post‐ICU bereavement period. Additionally, families consistently valued sufficient time with the deceased following death, unhurried opportunities for farewell (Bjelland and Jones 2022; Coventry et al. ²⁰²⁰), and others have also reported the importance of sensitive preparation of the body (Bloomer et al. 2023). Some interventions are implemented further after death, including post‐ICU follow‐up telephone calls, letters, condolence cards, meetings, and in some contexts, funeral attendance, with the aim of continuing to support family members during bereavement. While post‐ICU follow‐up bereavement interventions contributed to family satisfaction, their impact on longer‐term psychological, social or physiological morbidity or mortality was rarely evaluated and reported. Many interventions were delivered as multicomponent care bundles, limiting the ability to attribute effects to individual elements. Although evidence suggests that bundled care approaches may reduce the risk of prolonged grief (Brekelmans et al. 2022; Rait et al. ²⁰²¹), further research is required to determine which components are effective, for whom, and at what time points. Of note, formal ICU bereavement follow‐up services are limited worldwide (Butler et al. 2024; Egerod et al. ²⁰¹⁹; McAdam and Erikson ²⁰¹⁶). The limited availability of formal bereavement follow‐up services in ICUs further highlights the need for scalable, flexible, and individualised models of post‐ICU bereavement care that support families without inadvertently contributing to their distress.

End‐of‐life and bereavement care in the ICU is inherently complex, and this review demonstrates wide variation in how interventions are implemented across settings and clinical contexts. Although strategies such as communication support, shared decision‐making, memory making, spiritual care, and bereavement follow‐up are commonly described, they are delivered inconsistently and often without rigorous evaluation from the family. As a result, it remains difficult to determine which intervention components best promote emotional adjustment, which families are most likely to benefit, and when during the illness or bereavement trajectory they should be introduced. These challenges were reflected across the included systematic reviews, which differed substantially in methodological approaches, intervention descriptions, and outcome definitions, limiting the ability to draw clear, comparative conclusions.

A central message from this review is the importance of tailoring bereavement care to each family's needs, values, and preferences, offering both task‐based supports (e.g., written summaries, condolence letters, resource brochures) and therapeutic interventions (e.g., timely, compassionate, communication; flexible shared decision making; presence at the bedside; personalised memory making) and matching these to family readiness, preferences, and cultural context. Families consistently valued choice, agency, and increased perceived control, qualities closely linked to improved experience and grief adjustment. Yet the evidence base remains limited in clarity where many interventions are multicomponent bundles, described inconsistently, or lack rigorous testing with families, reducing confidence in attributing independent effects. Consequently, while family‐focused end of life and bereavement interventions have broad, meaningful impacts on acceptance and coping, the evidence base needs more robust, standardised, and comparative research involving families to guide equitable, high‐quality care across ICU populations.

5. Limitations

Data from the included systematic reviews were presented as a narrative summary of the available evidence, and in some cases relied on results from single primary studies. Several interventions were complex and evaluated using inconsistent methods, limiting the ability to provide more detailed interpretation and requiring findings to be summarised rather than synthesised. Results were reported according to data from each systematic review, and comparative effectiveness across interventions was intentionally avoided consistent with Cochrane's guidance for overview of reviews (Pollock et al. 2024). As this overview of reviews was limited to the data contained within included systematic reviews, primary studies not captured by those systematic reviews were not represented, potentially limiting the full scope of available evidence. Overview of reviews are also inherently constrained by the methodological quality and reporting choices of the included systematic reviews, including their inclusion criteria, data extraction processes, and level of detail reported. In addition, one included systematic review was authored by AEB; however, to maintain neutrality, they were not involved in screening, extraction, or critical appraisal decisions for that paper. Despite these limitations, this review provides a consolidated summary of a large body of evidence in a single resource.

6. Conclusion

This overview of reviews brings together a large and diverse body of evidence into a single, coherent resource, providing a comprehensive summary of evaluated family‐focused end of life and bereavement interventions in ICU settings. Collectively, the findings demonstrate that these interventions can offer meaningful and valued support to families. Across the neonatal, paediatric, and adult literature, consistently valued aspects of care were those that were individualised and relational, and reflected elements of culturally responsive care, including compassionate communication, opportunities for presence, and support that honours families' values, beliefs, and readiness. These findings highlight key concepts that can inform the design of future end‐of‐life and bereavement care interventions.

While variations in intervention design, timing, and evaluation limits definitive conclusions about effectiveness, this summary clarifies the core components and practices most consistently reported by families, highlighting areas most promising for further development. By consolidating existing evidence, this review provides a strong foundation on which more robust, standardised, and context‐appropriate interventions can be designed, implemented, and evaluated with families. Advancing practice in this area will require building on this consolidated knowledge to develop and evaluate interventions that are both structured and flexible, enabling high‐quality end‐of‐life care and bereavement support to be delivered consistently across diverse ICU populations.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information: S1. Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist (Gates et al. 2022).

Supporting Information: S2 Sample database search in Ovid MEDLINE.

Supporting Information: S3 Details of the risk of bias assessed from the included systematic reviews using ROBIS tool (Whiting et al. 2016).

Supporting Information: S4 Matrix of evidence (ROBIS tool) indicating the inclusion of individual primary studies within each systematic review. A value of “1” indicates that the primary study was included in the systematic review, while “X” indicates time‐dependent gaps where primary studies could not have been included due to publication after the search period of the systematic review (Perez‐Bracchiglione et al. ²⁰²²).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.