New developments in the provision of family-centered care in the intensive care unit

Excerpt

There is increasing recognition of the important role of family members in the ICU and there are four compelling reasons that ICU clinicians should incorporate family members into the provision of critical care. First, critical illness of a loved one has enormous effects on family members of the patient with approximately one-quarter to half of family members of critically ill experiencing significant psychological symptoms, including acute stress, post-traumatic stress, generalized anxiety, and depression both during and after the critical illness of their loved one [1‐3]. The combined impact on family members may result in what has been termed “post-intensive care syndrome-family” (PICS-F) [3, 4]. Importantly, clinician communication behaviors are associated with these psychological symptoms, highlighting the importance of supporting family members during critical illness [1]. Second, family members are often placed in the position of acting as surrogate decision-makers for critically ill patients and support for and effective communication with family members will facilitate high quality and ethical shared decision-making in the ICU [5]. In addition, being involved in surrogate decision-making is associated with higher levels of distress among family members and matching family preference for role in decision-making may reduce this stress [5, 6]. Third, patients often want family members involved in decision-making about their care and most patients with chronic illness report that their family members’ perspectives should take precedence over their own advance directives [7]. Finally, there is some evidence outside the ICU that supporting family members may improve patient outcomes by allowing family to be more effective caregivers [3, 8]. For all these reasons, high quality family-centered care should be considered a basic skill for ICU clinicians. …