Prevalence and Impact of Traumatic Life Events among Black and White Family Members of ICU Patients.

Abstract

Rationale: Lifetime trauma is common and may affect interactions with the healthcare system.

Objective: To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU).

Methods: Cross-sectional study conducted in nine ICUs in one urban and one suburban-rural health system. Participants were Black or White surrogate decision-makers for mechanically ventilated patients. Independent variables were the number of lifetime traumatic events measured using the Life Stressor Checklist-Revised (LSC-R), and secondarily and separately, discrimination-related traumatic stress symptoms. The primary outcome was family-reported conflict with ICU clinicians about treatment decisions. Secondary outcomes were family-reported quality of clinician communication and therapeutic alliance.

Results: Among 141 family members (median age 52.7 years [IQR 41.9, 62.0]; female n=100, 70.9%; White n=85, 60.3%; Black n=56, 39.7%), the median number of lifetime traumatic events was 6.0 (IQR 4.0, 9.0). Lifetime trauma was significantly but non-linearly associated with family-clinician conflict (OR=1.44, 95% CI: 1.09,1.90 for LSC-R values 0-7.5; OR=0.75, 95% CI: 0.55, 1.02 for LSC-R values 7.5-16; p=0.03). Discrimination-related stress symptoms were also associated with conflict (OR=1.04, 95% CI: 1.003, 1.07; p=0.03). Interactions between the independent variables and family member race were not significant, suggesting the effects of lifetime trauma and discrimination-related traumatic stress on family-clinician conflict were similar for Black and White caregivers.

Conclusions: Lifetime trauma is common among families of critically ill patients and is associated with negative experiences of critical care. Trauma-informed care may reduce family-clinician conflict and improve other measures of family experience.