Daily Written Care Summaries for Families of Critically Ill Patients: A Randomized Controlled Trial*

Abstract

OBJECTIVES: 

To determine the effect of daily written updates on the satisfaction and psychologic symptoms of families of ICU patients.

DESIGN: 

Randomized controlled trial.

SETTING: 

Single, urban academic medical center.

SUBJECTS: 

Surrogates of nondecisional, critically ill adults with high risk of mortality (n = 252) enrolled from June 2019 to January 2021.

INTERVENTIONS: 

Usual communication with the medical team with or without written communication detailing the suspected cause and management approach of each ICU problem, updated each day.

MEASUREMENTS AND MAIN RESULTS: 

Participants completed surveys at three time points during the ICU stay: enrollment (n = 252), 1 week (n = 229), and 2 weeks (n = 109) after enrollment. Satisfaction with care was measured using the Critical Care Family Needs Inventory (CCFNI). The presence of anxiety, depression, and acute stress were assessed using the Hospital Anxiety and Depression Scale (HADS) and Impact of Events Scale Revised (IES-R). CCFNI, HADS, and IES-R scores were similar among participants assigned to the intervention group and control group upon enrollment and during the first week after enrollment (p > 0.05). From enrollment to the second week after enrollment, there was an improvement in CCFNI and HADS scores among participants assigned to the intervention group versus the control group. At week 2, CCFNI scores were significantly lower among participants in the intervention group versus the control group, indicating greater satisfaction with care: 15.1 (95% CI, 14.2–16.0) versus 16.4, (95% CI, 15.5–17.3); p = 0.04. In addition, 2 weeks after enrollment, the odds of symptoms of anxiety, depression, and acute stress among participants assigned to the intervention versus control group were 0.16 (95% CI, 0.03–0.82; p = 0.03); 0.15 (95% CI, 0.01–1.87; p = 0.14); and 0.27 (95% CI, 0.06–1.27; p = 0.10), respectively.

CONCLUSIONS: 

Written communication improved satisfaction and the emotional well-being of families of critically ill patients, supporting its use as a supplement to traditional communication approaches.