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Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis

Goldfarb, Michael J. MD1; Bibas, Lior MD2; Bartlett, Virginia PhD3; Jones, Heather MD4; Khan, Naureen MD5

doi: 10.1097/CCM.0000000000002624
Review Article

Objective: To determine whether patient- and family-centered care interventions in the ICU improve outcomes.

Data Sources: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016.

Study Selection: We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs.

Data Extraction: We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes.

Data Synthesis: There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95–1.21; p = 0.27; I2 = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, –2.25 to –0.16; p = 0.02; I2 = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis.

Conclusions: Patient- and family-centered care–focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.

1Divisions of Cardiology and Critical Care, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

2Division of Cardiology, Department of Medicine, McGill University, Montreal, QC, Canada.

3Center for Healthcare Ethics, Cedars-Sinai Medical Center, Los Angeles, CA.

4Divisions of Pulmonary and Critical Care, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

5Division of Supportive Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Goldfarb is supported by a grant from the Joe Weider Foundation. The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: michael.goldfarb@cshs.org

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