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Hwang, David; Robinson, Jennifer; Bautista, Cynthia; White, Jessica; McAnaney, Meghan; Coppola, Anna; Poskus, Kelly
Critical Care Medicine: December 2013
doi: 10.1097/01.ccm.0000440068.30206.00
Poster Session: Patient & Family Support 1: PDF Only

Introduction: Existing studies suggest that family members who have previously been involved as family of intensive care unit (ICU) patients report similar levels of overall satisfaction with ICU care for a current admission when compared to those without prior ICU experience. Whether previous ICU experiences influence families' feelings specifically regarding shared decision making in critical care is unclear. Methods: From December 2012 to May 2013, as part of a currently ongoing research protocol, a multidisciplinary team in an academic neuroscience ICU administered the previously validated FS-ICU 24 survey to a consecutive cohort of families at time of discharge. Only those families whose relatives were admitted for less than 72 hours or whose relatives passed away during NICU admission were excluded. Likert-scales were dichotomized between the highest rating possible (i.e., 'complete satisfaction') and remaining responses. Comparison between groups was performed using Fisher's exact test. Results: Of 121 eligible patient families, a total of 67 families (55.4%) had one member complete the survey, with 41 (61.2%) reporting prior ICU experience on the survey and 26 (38.8%) reporting no prior experience. With regards to complete satisfaction, there was no difference seen between groups for any of the 10 FS-ICU 24 items that address aspects of the decision-making process. Comparing those with prior experience to those without, similar levels of complete satisfaction were notable for understanding of information (75.6% vs. 76.9%, p = 1.00), as well as with inclusion in (70.7% vs. 61.5%, p = 0.59) support during (53.6% vs. 52.0%, p =1.00), and control over (58.5% vs. 54.2%, p = 0.80) shared decision making. There was no difference between groups with regards to patient age, sex, length of stay, APACHE II score, or insurance status; also, no difference was seen with respect to survey respondent age, sex, race, or number of formal family meetings experienced. Conclusions: Families reporting prior involvement with relatives in ICUs do not experience higher levels of satisfaction with the ICU shared decision-making process compared to those new to the ICU. Efforts to better educate and involve family members of ICU patients regarding shared decision making should be made, independent of the extent of their prior ICU experience.

(C) 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins