Patient and family involvement in adult critical and intensive care settings: a scoping review

Abstract

Background: Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings.

Objective: This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined.

Methods: Searches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English-language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis.

Findings: A total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed-methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care.

Conclusion: Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio-cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.

Keywords: Critical care; Intensive care units; family involvement; family-centred care; patient involvement; patient-centred care; scoping review.

Figure 1

Flow diagram of study methodology. This flow diagram illustrates our study selection process, which culminated in a total count of 124 included studies. [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 2

This diagram depicts the components of family involvement investigated within the empirical literature on intensive care units. These categories of involvement are not mutually exclusive, but rather represent subsequent and progressive components of involvement along a continuum from relatively passive to active forms. [Colour figure can be viewed at wileyonlinelibrary.com]