To assess the feasibility and efficacy of implementing “Family
Care Rituals” as a means of engaging family
members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family
Prospective, before-and-after intervention evaluation.
Two U.S. academic medical ICU’s, and one Italian academic medical/surgical ICU.
members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission.
A novel intervention titled “Family
Care Rituals” during which, following a baseline observation period, family
members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay.
Measurements and Main Results:
Primary outcome was symptoms of post-traumatic
stress disorder in family
members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family
satisfaction. At 90-day follow-up, 131 of 226 family
members (58.0%) responded preintervention and 129 of 226 family
members (57.1%) responded postintervention. Symptoms of post-traumatic
stress disorder were significantly higher preintervention than postintervention (39.2% vs 27.1%; unadjusted odds ratio, 0.58; p
= 0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%; unadjusted odds ratio, 0.93; p
= 0.818), anxiety (41.0% vs 45.5%; unadjusted odds ratio, 1.20; p
= 0.234), or mean satisfaction scores (85.1 vs 89.0; unadjusted odds ratio, 3.85; p
= 0.052) preintervention versus postintervention 90 days after patient death or ICU discharge.
Offering opportunities such as family
care rituals for family
members to be involved with providing care for family
members in the ICU was associated with reduced symptoms of post-traumatic
stress disorder. This intervention may lessen the burden of stress-related symptoms in family
members of ICU patients.