Hola a todos, my dear friends.

Today we are talking about a very interesting open Access article in Intensive Care, published by Drs. Gerritsen, Hartog and Curtis about existing evidence on families-ICU relationship.

There is a global trending awareness of the importance family members in the ICU, and the authors point out four reasons why everyone should be incorpórate the relatives in the therapeutic team.

1. Critical illness of a loved one has huge effects on family members (up to 25% suffer psychological symptoms, and post-ICU family symdrome could appear).
2. Family often becomes responsible for decision-making, so support them and effective communication is the key.
3. Patients want their families to share decision making about their care.
4. Supporting family members make them more effective caregivers.

In the recent clinical practice guideline on family centered care by Davidson et al, already commented in this space by José Manuel Velasco, a systematic review of the literature was conducted using the  GRADE methodology, and they made 23 recommendations that were rated as weak evidence. The five areas were: family presence in the ICU, family support, communication with family, use of specific consultations with specialists/members of the ICU team’s and management and environmental aspects. Don’t miss the table of the article that summarizes these aspects and their level of evidence.

Recommendations supported by moderate or weak quality of evidence

Category

Recommendations

Quality of evidence (B = moderate; C = low)

Family presence in the ICU

Family members of critically ill patients be offered the option of participating in interdisciplinary team rounds to improve satisfaction with communication and increase family engagement

C

Family members of critically ill patients be offered the option of being present during resuscitation efforts, with a staff member assigned to support the family

C

Family support

Family members of critically ill neonates be offered the option to be taught how to assist with the care of their critically ill neonate to improve parental confidence and competence in their caregiving role and improve parental psychological health during and after the ICU stay

B

Family education programs be included as part of clinical care as these programs have demonstrated beneficial effects for family members in the ICU by reducing anxiety, depression, post-traumatic stress, and generalized stress while improving family satisfaction with care

C

ICUs provide family with leaflets that give information about the ICU setting to reduce family member anxiety and stress

B

ICU diaries be implemented in ICUs to reduce family member anxiety, depression, and post-traumatic stress

C

Among surrogates of ICU patients who are deemed by a clinician to have a poor prognosis, clinicians use a communication approach, such as the “VALUE” mnemonic (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions), during family conferences to facilitate clinician–family communication

C

Communication with family members

Routine interdisciplinary family conferences be used in the ICU to improve family satisfaction with communication and trust in clinicians and to reduce conflict between clinicians and family members

C

Healthcare clinicians in the ICU should use structured approaches to communication, such as that included in the “VALUE” mnemonic, when engaging in communication with family members, specifically including active listening, expressions of empathy, and making supportive statements around nonabandonment and decision-making. In addition, we suggest that family members of critically ill patients who are dying be offered a written bereavement brochure to reduce family anxiety, depression, and post-traumatic stress and improve family satisfaction with communication

C

Use of specific consultations and ICU team members

Proactive palliative care consultation be provided to decrease ICU and hospital length of stay among selected critically ill patients (e.g., advanced dementia, global cerebral ischemia after cardiac arrest, patients with prolonged ICU stay, and patients with subarachnoid hemorrhage requiring mechanical ventilation)

C

Ethics consultation be provided to decrease ICU and hospital length of stay among critically ill patients for whom there is a value-related conflict between clinicians and family

C

Family navigators (care coordinator or communication facilitator) be assigned to families throughout the ICU stay to improve family satisfaction with physician communication, decrease psychological symptoms, and reduce costs of care and length of ICU and hospital stay

C

Operational and environmental issues

Protocols be implemented to ensure adequate and standardized use of sedation and analgesia during withdrawal of life support

C

Hospitals implement policies to promote family-centered care in the ICU to improve family experience

C

Despite this relatively weak evidence, there are many interventions that can be recommended on the basis of the existing evidence. Each individual ICU should review these recommendations (as the same we check, study and know other guidelines in other areas of knowledge in critical care), to decide what interventions have sense and are feasible according to current results, the interests of the team and the resources available.

Family-centered care should be considered as maximum quality of care in every ICU: common sense actions that can be implemented without major economic investments or special technology. But pay attention: making these changes without training ourselves could be a mistake and to avoid this, Proyecto HU-CI is committed to training in #humantools.

In any case, we continue researching to demonstrate the evidence of what is obvious.

Happy Wednesday,
Gabi