Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Mar 1;52(3):420-431.
doi: 10.1097/CCM.0000000000006093. Epub 2023 Nov 7.

Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial

Boukje M Dijkstra  1   2 , Paul J T Rood  1   2 , Steven Teerenstra  3 , Anne M F Rutten  4 , Crista Leerentveld  5 , Dominique C Burgers-Bonthuis  6 , Barbara Festen-Spanjer  7 , Toine Klarenbeek  8 , Mark Van Den Boogaard  2 , Esther Ewalds  9 , Lisette Schoonhoven  10   11 , Johannes G Van Der Hoeven  2 , Lilian C M Vloet  1   12   13 ; from the EFfect of FAMily PARTicipation in essential care (EFFAMPART) Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial

Boukje M Dijkstra et al. Crit Care Med. .

Abstract

Objectives: To determine the effect of a standardized program for family participation in essential care activities in the ICU on symptoms of anxiety, depression, posttraumatic stress and satisfaction among relatives, and perceptions and experiences of ICU healthcare providers (HCPs).

Design: Multicenter stepped-wedge cluster randomized controlled trial.

Setting: Seven adult ICUs, one university, and six general teaching hospitals.

Participants: Three hundred six relatives and 235 ICU HCPs.

Interventions: A standardized program to facilitate family participation inpatient communication, amusement/distraction, comfort, personal care, breathing, mobilization, and nutrition.

Measurements and main results: Data were collected through surveys among relatives and ICU HCPs. There were no significant differences in symptoms of anxiety in relatives in the intervention period compared with the control period (median Hospital Anxiety and Depression Scale [HADS] 5 [interquartile range (IQR) 2-10] vs 6 [IQR 3-9]; median ratio [MR] 0.72; 95% CI, 0.46-1.13; p = 0.15), depression (median HADS 4 [IQR 2-6] vs 3 [IQR 1-6]; MR 0.85; 95% CI, 0.55-1.32; p = 0.47) or posttraumatic stress (median Impact of Event Scale-Revised score 0.45 [IQR 0.27-0.82] vs 0.41 [IQR 0.14-1]; MR 0.94; 95% CI, 0.78-1.14; p = 0.54). Reported satisfaction was slightly lower in the intervention period (mean 8.90 [ sd 1.10] vs mean 9.06 [ sd 1.10], difference -0.60; 95% CI, -1.07 to -0.12; p = 0.01). ICU HCPs perceived that more relatives knew how to participate: 47% in the intervention period versus 22% in the control period (odds ratio [OR] 3.15; 95% CI, 1.64-6.05; p < 0.01). They also reported relatives having sufficient knowledge (41% vs 16%; OR 3.56; 95% CI, 1.75-7.25; p < 0.01) and skills (44% vs 25%; OR 2.38; 95% CI, 1.22-4.63; p = 0.01) to apply family participation.

Conclusions: Application of a standardized program to facilitate family participation did not change mental health symptoms in relatives of ICU patients 3 months after discharge. ICU HCPs reported increased clarity, knowledge, and skills among relatives and ICU HCPs.

PubMed Disclaimer

Conflict of interest statement

Prof. Vloet’s institution received funding from the Dutch Research Council (Netherlands Organization for Scientific Research [NWO] Foundation Innovation Alliance, Regional Attention and Action for Knowledge circulation [RAAK SIA] (RAAK.PUB06.017). Dr. Rutten’s, Mrs. Leerentveld’s, Dr. Burgers-Bonthuis’, Dr. Festen-Spanjer’s, Mrs. Klarenbeek’s, Prof. Van Den Boogaard’s, and Dr. Ewalds’ institutions received funding from NWO, RAAK/-SIA. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
The Effect of Family Participation program menu. The menu below was adapted for low-literacy relatives or relatives from different cultural backgrounds, who have difficulty reading Dutch, printed double-sided and laminated. It contains similar information with pictures on the front and text on the back (Supplemental file 1, http://links.lww.com/CCM/H442).
Figure 2.
Figure 2.
Flow diagram.
See this image and copyright information in PMC

References

    1. Needham DM, Davidson J, Cohen H, et al. : Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference. Crit Care Med. 2012; 40:502–509 - PubMed
    1. Davidson JE, Jones C, Bienvenu OJ: Family response to critical illness: Postintensive care syndrome-family. Crit Care Med. 2012; 40:618–624 - PubMed
    1. Garrouste-Orgeas M, Willems V, Timsit JF, et al. : Opinions of families, staff, and patients about family participation in care in intensive care units. J Crit Care. 2010; 25:634–640 - PubMed
    1. Davidson JE, Aslakson RA, Long AC, et al. : Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017; 45:103–128 - PubMed
    1. Olding M, McMillan SE, Reeves S, et al. : Patient and family involvement in adult critical and intensive care settings: A scoping review. Health Expect. 2016; 19:1183–1202 - PMC - PubMed

Publication types