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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.

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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.

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