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Symptom experiences of family members of intensive care unit patients at high risk for dying

McAdam, Jennifer L. RN, PhD; Dracup, Kathleen A. RN, FNP, DNSc, FAAN; White, Douglas B. MD, MAS; Fontaine, Dorothy K. RN, PhD, FAAN; Puntillo, Kathleen A. RN, DNSc, FAAN

Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181cf6d94
Clinical Investigations
Abstract

Objective: To describe the symptom experiences of family members of patients at high risk for dying in the intensive care unit and to assess risk factors associated with higher symptom burden.

Design: Prospective, cross-sectional study.

Setting: Three intensive care units at a large academic medical center.

Participants: A sample of 74 family members of 74 intensive care unit patients who had a grave prognosis and were judged to be at high risk for dying. Patients at high risk for dying were identified as having Acute Physiology and Chronic Health Evaluation II scores >20, an intensive care unit length of stay >72 hrs, and being mechanically ventilated.

Interventions: None.

Measurements and Results: We assessed the degree of symptom burden approximately 4 days after the patient's admission to the intensive care unit in the following domains: traumatic stress, anxiety, and depression. Overall, the prevalence of symptoms was high, with more than half (57%) of family members having moderate to severe levels of traumatic stress, 80% having borderline symptoms of anxiety, and 70% having borderline symptoms of depression. More than 80% of family members had other physical and emotional symptoms, such as fatigue, sadness, and fear, and these were experienced at the moderate to severe levels of distress. Factors independently associated with greater severity of symptoms included younger age, female gender, and non-white race of the family member. The only patient factor significantly associated with symptom severity was younger age. Despite their symptom experience, the majority of the family members were coping at moderate to high levels and functioning at high levels during the intensive care unit experience.

Conclusions: We document a high prevalence of psychological and physical symptoms among family members during an intensive care unit admission. These data complement existing data on long-term symptom burden and highlight the need to improve family centered care in intensive care units.

Author Information

From Nursing Department (JLM), Dominican University of California, San Rafael, CA; School of Nursing (KAD, KAP), University of California, San Francisco, San Francisco, CA; Department of Medicine (DAW), University of Pittsburgh Medical Center, PA; School of Nursing (DKF), University of Virginia, Charlottesville, VA.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: jennifer.mcadam@dominican.edu or kathleen.puntillo@nursing.ucsf.edu

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins