Clinical PotpourriFamily experience with intensive care unit care: Association of self-reported family conferences and family satisfaction☆,☆☆
Introduction
Yearly, more than 5.7 million Americans are admitted to an intensive care unit (ICU) [1]. Intensive care unit rates of mortality range from 10% to 15%, representing more than 540 000 US deaths each year [2]. Concerns with respect to quality of end-of-life care and communication with families in the ICU have been reported [3], [4]. Most critically ill patients do not have decision-making capabilities and are often unable to communicate with the health care team because of their illness or the effect of treatments rendered, such as mechanical ventilation and sedation [5]. Family members of the critically ill patient are often required to act as surrogate decision makers, a role in which they may experience significant stress and emotional burden [6]. Improved communication with families of patients admitted to an ICU has been shown to reduce ICU length of stay, increase referrals to hospice, and, when appropriate, result in earlier withdrawal of life-sustaining interventions [7], [8]. Effective communication with families has also been shown to improve family satisfaction and psychological well-being [9].
Several areas have been identified as opportunities for improvement with regard to clinician-family communication in the ICU. Families often do not understand even basic information about the patient's diagnosis, prognosis, or treatment after 48 hours of admission to ICU [10], and physicians often miss opportunities to listen, acknowledge, and address emotions of families and do not explain surrogate decision making [11]. Poor physician communication and poor coordination of care are correlated with reduced family satisfaction with care [12], [13]. Conversely, factors associated with improved family satisfaction include high-quality communication and collaboration between nursing staff and providers [14].
National guidelines with regard to palliative care for patients admitted to the ICU Include the performance of an interdisciplinary family conference for patients and families within 72 hours of admission to an ICU [15]. Despite the recognition of the positive contribution of interdisciplinary family conferences as a component of high-quality ICU care, the mechanism by which family satisfaction and well-being are improved has not been well characterized. As part of an initiative to improve the quality of palliative care for patients in the ICU, we performed a baseline survey of family experiences. We undertook analysis of the data derived from the survey and clinical data from the electronic health record (EHR) to explore the association of occurrence of family conferences as reported by families with family-reported satisfaction with the care provided and the satisfaction with the decision-making process.
Section snippets
Materials and methods
We conducted a retrospective cohort study using family satisfaction surveys and an EHR data pull to gather baseline satisfaction with care and the medical decision-making process for patients and families cared for in the ICU.
The Family Satisfaction in the Intensive Care Unit Questionnaire24 (FS-ICU24) is a 24-item validated instrument for assessing family satisfaction in the ICU [16]. The instrument is available in public domain and can be accessed through the Canadian Researchers at the End
Results
Of the 453 surveys that were mailed, 16 NOK chose to opt out, leaving 437 records for analysis. Of the NOK surveyed, 243 responded, representing a 55.6% response rate. The subset of patients whose NOK responded to the survey had similar characteristics when compared with those who did not respond (Table 1). A total of 108 (44.4%) of 243 patients’ families reported that they had a family meeting. The average age of the patients whose families responded to the survey was 60.5 years, 38.4% were
Discussion
Family conferences offer a forum for bringing patients, family members, and health care providers together to share prognostic information, set goals of care, and offer families support. Several studies have evaluated the impact of communication strategies that include proactive family conferences upon clinical outcomes. These interventions have tended to be performed on select, high-acuity or specific patient populations including multiorgan failure [18], cerebral ischemia [19], poor prognosis
Conclusions
A family conference occurrence, as reported by NOK of patients admitted to the ICU, is associated with increased satisfaction with decision making. This study emphasizes the need to increase communication with families in ICUs and the use of multidisciplinary family conference as an important modality of communication. Further studies are needed to understand the most reliable workflow for holding multidisciplinary family conferences. Other modalities besides a multidisciplinary family
References (23)
- et al.
Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death: a prospective multicenter study
J Crit Care
(2005) - et al.
An intensive communication intervention for the critically ill
Am J Med
(2000) - et al.
Point: the ethics of unilateral “do not resuscitate” orders: the role of “informed assent”
Chest
(2007) - et al.
Impact of a proactive approach to improve end-of-life care in a medical ICU
Chest
(2003) - et al.
Family satisfaction in the ICU differences between families of survivors and nonsurvivors
Chest J
(2007) - et al.
How big is critical care in the U.S.?
Crit Care Med
(2003) - et al.
Use of intensive care at the end of life in the United States: an epidemiologic study
Crit Care Med
(2004) - et al.
Meeting the needs of intensive care unit patient families: a multicenter study
Am J Respir Crit Care Med
(2001) - et al.
Improving palliative care for patients in the intensive care unit
J Palliat Med
(2005) - et al.
Increasing incidence of withholding and withdrawal of life support from the critically ill
Am J Respir Crit Care Med
(1997)
Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients
Crit Care Med
Cited by (38)
A systematic scoping review of patient and caregiver self-report measures of satisfaction with clinicians’ communication
2023, Patient Education and CounselingFamily experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic
2023, Australian Critical CareFactors associated with family satisfaction in the adult intensive care unit: A literature review
2022, Australian Critical CareCitation Excerpt :Family member gender (female) was positively associated with family satisfaction in one high-quality10 and one moderate-quality study,23 but in most of the studies, a nonsignificant association was found.13,15–22,25,28,31,33 Regarding the associations between family satisfaction and kinship to the patient, two moderate-quality studies found opposite associations between being spouse/partner and family satisfaction20,21 but a positive relationship for being a sibling in a high-quality study.10 Conversely, 69.2% (n = 9) of the studies reporting this association found a nonsignificant relationship.13,16,17,19,22,25,31,33,34
Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation
2021, Australian Critical CareCitation Excerpt :White et al.,23 who investigated a nurse-facilitated family support pathway for surrogate decision-makers, found a statistically significant increase in quality of communication and perception of person-centredness, but did not investigate satisfaction with care. Our study, together with others, suggest that information support, communication over time, and a facilitator role are associated with satisfaction with ICU care,24,52,53 but more research is needed to tease out the mechanisms through which a particular intervention or component thereof increases satisfaction with care and family wellbeing. Our intervention failed to demonstrate a reduction in post-ICU psychosocial distress, which is consistent with previous trials investigating family support interventions that entailed a specific family navigator role.21,23
Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study
2020, Intensive and Critical Care Nursing
- ☆
All work was performed at Geisinger Health System, Danville PA, USA.
- ☆☆
Financial support was provided by Geisinger Clinic. There were no conflicts of interest for any of the authors.