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Randomized Controlled Trial
. 2024 May;50(5):712-724.
doi: 10.1007/s00134-024-07390-y. Epub 2024 Apr 4.

A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients

Nancy Kentish-Barnes  1 , Elie Azoulay  2   3 , Jean Reignier  4   5 , Alain Cariou  3   6 , Antoine Lafarge  2 , Olivier Huet  7   8 , Thomas Gargadennec  7 , Anne Renault  9 , Virginie Souppart  2 , Pamela Clavier  4 , Fanny Dilosquer  4 , Ludivine Leroux  9 , Sébastien Légé  6 , Anne Renet  2 , Lyndia C Brumback  10   11 , Ruth A Engelberg  10   11 , Frédéric Pochard  2 , Matthieu Resche-Rigon  3   12 , J Randall Curtis  10   11
Affiliations
Randomized Controlled Trial

A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients

Nancy Kentish-Barnes et al. Intensive Care Med. 2024 May.

Abstract

Purpose: Suboptimal communication with clinicians, fragmented care and failure to align with patients' preferences are determinants of post intensive care unit (ICU) burden in family members. Our aim was to evaluate the impact of a nurse facilitator on family psychological burden.

Methods: We carried out a randomised controlled trial in five ICUs in France comparing standard communication by ICU clinicians to additional communication and support by nurse facilitators. We included patients > 18 years, with expected ICU length of stay > 2 days, chronic life-limiting illness, and their family members. Facilitators were trained to help families to secure care in line with patient's goals, beginning in ICU and continuing for 3 months. Assessments were made at baseline and 1, 3 and 6 months post-randomisation. Primary outcome was the evolution of family symptoms of depression over 6 months using a linear mixed effects model on the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included HADS-Anxiety, Impact of Event Scale-6, goal-concordant care and experience of serious illness (QUAL-E).

Results: 385 patients and family members were enrolled. Follow-up at 1-, 3- and 6-month was completed by 284 (74%), 264 (68.6%) and 260 (67.5%) family members respectively. The intervention was associated with significantly more formal meetings between the ICU team and the family (1 [1-3] vs 2 [1-4]; p < 0.001). There was no significant difference between the intervention and control groups in evolution of symptoms of depression over 6 months (p = 0.91), nor in symptoms of depression at 6 months [0.53 95% CI (- 0.48; 1.55)]. There were no significant differences in secondary outcomes.

Conclusion: This study does not support the use of facilitators for family members of ICU patients.

Trial registration: ClinicalTrials.gov NCT04133753.

Keywords: Communication; Family members; Intensive care; Nurse facilitator; Post-ICU burden.

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References

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    1. Azoulay E, Chevret S, Leleu G et al (2000) Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 28:3044–3049. https://doi.org/10.1097/00003246-200008000-00061 - DOI - PubMed

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