Family Care Rituals in the Intensive Care Unit to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members- A Multicenter, Multinational, Before-and-After Intervention Trial

Objective— To assess the feasibility and efficacy of implementing “Family Care Rituals” as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress related symptoms in family members. Design— Prospective, before-and-after intervention evaluation Setting— 2 United States academic medical ICU’s, and 1 Italian academic medical/surgical ICU Participants— Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission. Intervention— A novel intervention titled “Family Care Rituals” (FCR) during which, following a baseline observation period, family members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay. Measurements and Main Results— Primary outcome was symptoms of Post-Traumatic Stress Disorder (PTSD) in family members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family satisfaction. At 90 day follow-up, 131 of 226 family members (58.0%) responded pre-intervention and 129 of 226 family members (57.1%) responded post-intervention. Symptoms of PTSD were significantly higher pre-intervention than post-intervention (39.2% vs 27.1%, unadjusted OR 0.58, p=0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%, unadjusted OR 0.93, p=0.818), anxiety (41.0% vs 45.5%, unadjusted OR 1.20, p=0.234), or mean satisfaction scores (85.1 vs 89.0, unadjusted OR 3.85, p=0.052) pre- vs post-intervention 90 days after patient death or ICU discharge. Conclusions— Offering opportunities such as FCR for family members to be involved with providing care for family members in the ICU was associated with reduced symptoms of PTSD. This intervention may lessen the burden of stress related symptoms in family members of ICU patients.