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A4170 - Family Care Rituals in the Intensive Care Unit to Reduce Symptoms of Posttraumatic Stress Disorder in Family Members- A Multicenter Before-and-After Intervention Trial
Author Block: T. Amass1, G. Villa2, R. McFadden3, T. Walsh4, A. Palmisciano4, M. Yeow3, R. De Gaudio2, S. OMahony3, J. Curtis5, M. M. Levy6; 1Pulmonary Critical Care, Brown University/Rhode Island Hospital, Providence, RI, United States, 2Anesthesia/Critical Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy, 3Palliative Care, Rush Medical Center, Chicago, IL, United States, 4Pulmonary Critical Care Research Division, Brown University/Rhode Island Hospital, Providence, RI, United States, 5Univ of Washington Harborview Med Ctr, Seattle, WA, United States, 6Pulmonary Critical Care, Rhode Island Hospital, Providence, RI, United States.
Rationale-Deficiencies in ICU end-of-life care have been previously identified1-7; most are related to communication, decision making, sense of control, spirituality, preparation for death, and pain/symptom management. Symptoms of stress, anxiety or depression are related to these and may stem from factors that strip families of the ability to provide direct care or nurturing for their loved-ones. Qualitative studies suggest families want/value a role as a care-provider for their loved ones in the ICU8-9. We developed an intervention of family-centered rituals empowering family members to participate in the care of their loved ones.Methods- In a prospective, multicenter before-and-after trial, families of patients with attending-physician predicted ICU mortality >30% were considered for enrollment at 3 ICU’s (Rhode Island Hospital, Rush Medical Center, and Careggi Teaching Hospital, Italy). During both phases, survey data was collected from families upon enrollment and 90-days post-death/discharge of the patient from the ICU via telephone. Nurses completed surveys evaluating which family rituals were employed and evaluating the impact of the intervention on nursing work flow. During the intervention, families were introduced to Family Care Rituals (FCR) via brochures which included suggestions for bedside involvement in patient care. RESULTS- At 90-day follow up, 131/226 subjects (58.0%) pre-intervention and 129/226 (57.1%) post-intervention responded. Symptoms of PTSD were significantly reduced post-intervention (27.1% vs 39.2%, P=0.046). There was no difference in symptoms of depression (26.5% vs 25.2, P=0.818), anxiety (41.0% vs 45.5%, P=0.234), geometric-mean patient LOS (4.9 days vs 5.4 days, P=0.304), patient ICU mortality (25.7% vs 26.0%, P=0.963), occurrence of code status change (32.4% vs 35.4%, P=0.598), or mean FS-ICU 24 scores (85.1 vs 89.0, P=0.052) pre- vs post-intervention. There was a significant reduction in palliative-care consults (21.3% vs 11.8%, P=0.041) and spiritual-care consults (25.0% vs 8.7%, P=0.001) post-intervention. Of nurses who responded (N=524), 67.2% felt the intervention improved the quality of care delivered, 65.0% felt it improved their communication with the family, while 3.4% reported it reduced the quality of care delivered and 4.3% indicated that it hindered their ability to provide care for the rest of their assignment.CONCLUSIONS- FCR, when used to empower families to participate in hands-on care of patients admitted to the ICU with a predicted mortality >30%, reduced family symptoms of PTSD 90-days after patient death/discharge from the ICU. This is an important finding to aide in reducing the burden of stress related symptoms imparted to the family members of patients admitted to the ICU.