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
Practice Guideline
. 2025 Feb 1;53(2):e465-e482.
doi: 10.1097/CCM.0000000000006549. Epub 2025 Feb 21.

Society of Critical Care Medicine Guidelines on Family-Centered Care for Adult ICUs: 2024

David Y Hwang  1 , Simon J W Oczkowski  2 , Kimberley Lewis  2 , Barbara Birriel  3 , James Downar  4 , Christian E Farrier  5   6 , Kirsten M Fiest  6 , Rik T Gerritsen  7 , Joanna Hart  8 , Christiane S Hartog  9   10 , Gabriel Heras-La Calle  11 , Aluko A Hope  12 , Ann L Jennerich  13 , Nancy Kentish-Barnes  14 , Ruth Kleinpell  15 , Erin K Kross  13 , Andrea P Marshall  16 , Peter Nydahl  17   18 , Theodora Peters  19 , Regis G Rosa  20 , Elizabeth Scruth  21 , Nneka Sederstrom  22 , Joanna L Stollings  15 , Alison E Turnbull  23 , Thomas S Valley  24 , Giora Netzer  25 , Rebecca A Aslakson  26 , Ramona O Hopkins  27
Affiliations
Practice Guideline

Society of Critical Care Medicine Guidelines on Family-Centered Care for Adult ICUs: 2024

David Y Hwang et al. Crit Care Med. .

Abstract

Rationale: For staff in adult ICUs, providing family-centered care is an essential skill that affects important outcomes for both patients and families. The COVID-19 pandemic placed unprecedented strain on care of ICU families, and practices for family engagement and support are still adjusting.

Objectives: To review updated evidence for family support in adult ICUs, provide clear recommendations, and spotlight optimal family-centered care practices post-pandemic.

Panel design: The multiprofessional guideline panel of 28 individuals, including family member partners, applied the processes described in the Society of Critical Care Medicine Standard Operating Procedures Manual to develop and publish evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including panel selection, writing, and voting.

Methods: The guidelines consist of four content sections: engagement of families, support of family needs, communication support, and support of ICU clinicians providing family-centered care. We conducted systematic reviews for 15 Population, Intervention, Control, and Outcomes questions, organized among these content sections, to identify the best available evidence. We summarized and assessed the certainty of evidence using the GRADE approach. We used the GRADE evidence-to-decision framework to formulate recommendations as strong or conditional, or as best practice statements where appropriate. The recommendations were approved using an online vote requiring greater than 80% agreement of voting panel members to pass.

Results: Our panel issued 17 statements related to optimal family-centered care in adult ICUs, including one strong recommendation, 14 conditional recommendations, and two best practice statements. We reaffirmed the critical importance of liberalized family presence policies as default practice when possible and suggested options for family attendance on rounds and participation in bedside care. We suggested that ICUs provide support for families in the form of educational programs; ICU diaries; and mental health, bereavement, and spiritual support. We suggested the importance of providing structured communication for families and communication training for clinicians but did not recommend for or against any specific clinician-facing tools for family support or decision aids, based on current available evidence. We recommended that adult ICUs implement practices to systematically identify and reduce barriers to equitable critical care delivery for families and suggested that programs designed to support the wellbeing of clinicians responsible for family support be developed.

Conclusions: Our guideline panel achieved consensus regarding recommendations and best practices for family-centered care in adult ICUs.

PubMed Disclaimer

Conflict of interest statement

Dr. Hwang reports grant funding from the Neurocritical Care Foundation related to psychological support for caregivers of severe acute brain injury patients, grant funding from the National Institute of Neurological Disorders and Stroke related to stroke clinical trials, and honoraria from Patient-Centered Outcomes Research Institute (PCORI) related to patient engagement in research. Dr. Oczkowski received funding from Fisher & Paykel Healthcare. Dr. Birriel reports grant funding from the Pennsylvania Chapter of Society of Critical Care Medicine related to surrogate decision-making. Dr. Fiest reports grant funding from the Canadian Institutes of Health related to ICU family engagement. Dr. Heras-La Calle received funding from Pfizer. Dr. Jennerich reports grant funding from the National Heart, Lung, and Blood Institute (NHLBI) related to unplanned ICU admissions and family-centered outcomes. Dr. Kentish-Barnes reports institutional grant funding from the Assistance Publique Hopitaux de Paris Hospital and the French Ministry of Health related to family-centered care. Dr. Kleinpell reports grant funding from PCORI related to ICU patient and family engagement in research. Dr. Kross reports grant funding from the National Institute on Aging, National Institutes of Health, and NHLBI related to goals-of-care discussions and palliative care training. Dr. Rosa reports grant funding from the Brazilian Ministry of Health related to family-centered care. Dr. Turnbull reports grant funding from the NHLBI related to acute respiratory failure survivors. Dr. Valley reports grant funding from the NHLBI related to health equity for respiratory failure patients, consultant work with Baxter Healthcare related to health equity in ICU care, and consultant work with Consumer Reports related to racial bias in pulse oximetry; he disclosed government work. Dr. Netzer reports royalties from UpToDate and Springer Press. Dr. Hopkins reports grant funding from the Intermountain Medical and Research Foundation related to ICU family member outcomes. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Hume NE, Zerfas I, Wong A, et al.: Clinical impact of the implementation strategies used to apply the 2013 pain, agitation/sedation, delirium or 2018 pain, agitation/sedation, delirium, immobility, sleep disruption guideline recommendations: A systematic review and meta-analysis. Crit Care Med. 2024; 52:626–636
    1. Alspach JG: Overlooking an integral lynchpin of patient care: The caregiver at home. Crit Care Nurse. 2018; 38:10–15
    1. Zante B, Camenisch SA, Schefold JC: Interventions in post-intensive care syndrome-family: A systematic literature review. Crit Care Med. 2020; 48:e835–e840
    1. Davidson JE, Powers K, Hedayat KM, et al.; American College of Critical Care Medicine Task Force 2004-2005, Society of Critical Care Medicine: Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine task force 2004-2005. Crit Care Med. 2007; 35:605–622
    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

Publication types