Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review.

Objective: The objective of this review was to evaluate health care professionals' experiences when families participate in clinician handovers in adult, pediatric, and neonatal intensive care units (ICUs).

Introduction: Previous studies report the emotional distress families experience when a relative is admitted to intensive care, including an increased risk of post-traumatic stress disorder symptoms after discharge. Family involvement in patient care in ICU can improve safety and quality health care outcomes. Furthermore, family participation in clinician handovers may improve satisfaction with care, staff communication, and interpersonal relationships with families. However, health care professionals' attitudes toward family participation in multidisciplinary ward rounds are diverse, and little is known about their perspectives toward family participation in clinician handovers.

Inclusion criteria: Studies were included if they involved health care professionals and any type of family participation during handover, from bedside presence to participation in decision-making. Clinician handovers included multidisciplinary ward rounds or nursing handovers. Settings were adult, pediatric, or neonatal intensive care units in rural or metropolitan regions in any country. Studies in other clinical contexts were excluded. Qualitative studies were included, as well as mixed methods studies if qualitative data could be clearly extracted.

Methods: Databases searched included CINAHL Plus (EBSCOhost), MEDLINE (Ovid), Scopus, Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), ProQuest Central (including ProQuest Dissertations and Theses), Web of Science, MedNar, and Google Scholar, with limiters being English and the year range 2000 to present. The last search was in October 2024. Two reviewers independently screened the titles and abstracts and assessed the full-text articles that met inclusion criteria for methodological quality. Findings were extracted using the JBI data extraction tool and assigned a level of credibility. Meta-aggregation was used to synthesize the findings. Two reviewers discussed any disagreements to reach consensus and consulted a third reviewer when necessary.

Results: Eleven studies published from 2003-2024 were included for data extraction. Five studies were qualitative and 6 were mixed methods. Six studies were conducted in the United States, 4 in Canada, and 1 in Australia. Three studies were in adult ICUs, 5 in pediatric, 1 in neonatal, and 2 did not specify the ICU type. All studies were on multidisciplinary bedside rounds, while none were conducted on nursing handovers. The findings revealed that health care professionals generally supported family participation in clinician handovers due to benefits such as improved communication between the health care team and families. However, they also identified barriers, including families' emotional responses to bad news and impact on workflow and teaching opportunities during handovers. Planning, leadership, and clear communication were highlighted as crucial for successfully facilitating family participation in rounds.

Conclusions: While this review found that health care professionals value family participation in multidisciplinary bedside rounds, they experienced challenges. Future research is required to explore family participation in clinician handovers. Significant planning, investment and preparation is required to include families in ICU handovers.

Review registration: PROSPERO CRD42020223011.