Facilitating Communication for Family Members of Critically Ill Patients During and Following a Hospital Stay: A Randomized Controlled Trial.

Abstract

Objectives: Families of patients admitted to ICUs experience numerous care transitions, poor communication across these transitions, and emotional distress associated, in part, with the challenges of obtaining care consistent with patients' values. Specialized support from ICU to postacute setting may improve outcomes.

Design: Multicenter randomized, controlled trial of a "communication facilitator" intervention.

Setting: One healthcare system, three hospitals in Seattle, WA.

Participants: ICU patients ( n = 449) with chronic life-limiting illness (2-yr median survival, and/or acute, severe illness with greater than 15% hospital mortality risk) and their family members ( n = 505). Patients were the unit of randomization (control, n = 224; intervention, n = 225).

Interventions: Nurse communication facilitators trained to support, model, and teach communication strategies to promote goal-concordant care. Facilitators engaged with participants in the ICU and for 3 months postrandomization.

Measurement and main results: The primary outcome was family member depression, measured using the Hospital Anxiety and Depression Scale (HADS) at four time points (randomization, 1-, 3-, and 6-mo postrandomization). Among respondents, HADS-depression tended to decrease over time (mean ± sd = 7.2 ± 4.6 for control and 7.2 ± 4.2 for intervention at baseline; 5.9 ± 4.1 for control and 5.9 ± 4.5 for intervention at 6 mo). The difference in mean HADS-depression between intervention and control over 6 mo was not significantly different: -0.07 (95% CI, -0.70 to 0.55). Differences in family-reported secondary outcomes were in the expected direction, including relationship with the healthcare team ( p = 0.0162) and goal concordance ( p = 0.0504), but their effect sizes were small.

Conclusions: For family members of critically ill patients facing a high likelihood of death or serious disability, involving a communication facilitator during and after an ICU stay did not lead to a reduction in depressive symptoms.