# Enhancing communication with bereaved relatives about emergency and critical care trials (ENHANCE): a mixed-methods study

## TL;DR

This study explores how to best inform bereaved relatives about their loved one's participation in emergency or critical care research when prior consent was not obtained.

## Contribution

The study introduces a mixed-methods approach to evaluate communication strategies for informing bereaved relatives about research participation without prior consent.

## Key findings

- Most bereaved relatives valued being informed about their loved one's research participation, emphasizing transparency and trust.
- Automatic disclosure by the medical examiner service was seen as potentially burdensome by some relatives.
- Offering relatives the option to receive information soon after death was recommended as a sensitive approach.

## Abstract

Clinical research in emergency and critical care is vital, but recruitment and consent are complex. Research may be conducted without prior consent when patients are critically ill, and interventions are time critical. Some patients may die before research participation can be discussed with relatives, leaving the bereaved unaware of their involvement. This study explored potential communication strategies for informing bereaved relatives when a patient has died following enrolment into an emergency or critical care study without prior consent.

A mixed-methods study using a telephone survey and semi-structured interviews conducted simultaneously. The survey was conducted within a National Health Service Trust in North West England with relatives of deceased study participants. Semi-structured interviews were conducted with bereaved relatives and research and clinical staff across the UK, and medical examiner (ME)/ME officers based in England and Wales. Quantitative data were analysed descriptively, and qualitative data were analysed using reflexive thematic analysis. Data were synthesised using a constant comparison approach.

11 bereaved relatives completed the survey. 53 individuals (21 research and clinical staff, 18 relatives and 14 MEs/officers) participated in semi-structured interviews.

Although many trials do not include a process for notifying bereaved relatives about research participation, most relatives valued the opportunity to learn about their family member’s participation, emphasising the importance of transparency and trust. However, some raised concerns over the potential burden of automatic disclosure by the ME service. Offering bereaved relatives the option to receive sensitively worded information about research involvement at an appropriate time, soon after death, was recommended.

Bereaved relatives should have the choice to be informed about research participation without prior consent. Our findings support the need for transparent and sensitive communication and will contribute to future guidance for the design and conduct of adult emergency and critical care studies.