Family centeredness of care: a cross-sectional study in intensive care units part of the European society of intensive care medicine

Abstract

Purpose: To identify key components and variations in family-centered care practices.

Methods: A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate.

Results: The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6-8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness.

Conclusions: This study emphasizes the need to prioritize healthcare providers' mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.

Fig. 1

Ethical Decision Making Climate Questionnaire Score as a function of quartiles (Panel A) or continuous values (Panel B) of family centeredness. A visual analogue scale was used to assess the intensity of family centeredness. Two anchors were provided to family members for 0 (family centered care is not all a priority in our ICU) and 10 (family centered care is a major priority in our ICU)

Fig. 2

Median score of each of the seven distinct ethical climate factors part of the Ethical Decision Making Climate Questionnaire according to quartiles of family centeredness. Larger values of each factor indicate a more positive environment for decision making. A visual analogue scale was used to assess the intensity of family centeredness. Two anchors were provided to family members for 0 (family centered care is not all a priority in our ICU) and 10 (family centered care is a major priority in our ICU)

Fig. 3

Maslach Burnout Inventory (MBI) Scale and family centeredness. The three MBI domains, namely, emotional exhaustion, depersonalization, and personal accomplishment, are displayed according to quartiles of family centeredness in Panel A (clear gray bars for the lower quartile, black bars for the higher quartile). In Panel B1, B2 and B3, the three MBI domains are displayed according to continuous values of family centeredness. A visual analogue scale was used to assess the intensity of family centeredness. Two anchors were provided to family members for 0 (family centered care is not all a priority in our ICU) and 10 (family centered care is a major priority in our ICU)