Skip to main content
SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Access to data and data analysis: EA and MR-R had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. MR-R from the Saint-Louis hospital Paris, France, conducted and is responsible for the data analysis. Data sharing: according to the Sponsor rules, the AP-HP is the owner of the data and no use or transmission to a third party can be made without its prior agreement. The steering committee will facilitate the use of the data and approval will not be unreasonably withheld. De-identified participant data will be made available to bona fide researchers registered with an appropriate institution within 3 months of publication. However, the steering committee will need to be satisfied that any proposed publication is of high quality, honours the commitments made to the participants in the consent documentation and ethical approvals, and is compliant with relevant legal and regulatory requirements (e.g. relating to data protection and privacy). The steering committee will have the right to review and comment on any draft manuscripts before publication.

References

  1. Azoulay E, Pochard F, Kentish-Barnes N et al (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994. https://doi.org/10.1164/rccm.200409-1295OC

    Article  PubMed  Google Scholar 

  2. Curtis JR, Vincent J-L (2010) Ethics and end-of-life care for adults in the intensive care unit. Lancet 376:1347–1353. https://doi.org/10.1016/S0140-6736(10)60143-2

    Article  PubMed  Google Scholar 

  3. Long AC, Kross EK, Davydow DS, Curtis JR (2014) Posttraumatic stress disorder among survivors of critical illness: creation of a conceptual model addressing identification, prevention, and management. Intensive Care Med 40:820–829. https://doi.org/10.1007/s00134-014-3306-8

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kentish-Barnes N, Chaize M, Seegers V et al (2015) Complicated grief after death of a relative in the intensive care unit. Eur Respir J 45:1341–1352. https://doi.org/10.1183/09031936.00160014

    Article  PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. Pronovost PJ, Angus DC, Dorman T et al (2002) Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 288:2151–2162. https://doi.org/10.1001/jama.288.17.2151

    Article  PubMed  Google Scholar 

  7. Tulsky JA, Beach MC, Butow PN et al (2017) A research agenda for communication between health care professionals and patients living with serious illness. JAMA Intern Med 177:1361. https://doi.org/10.1001/jamainternmed.2017.2005

    Article  PubMed  Google Scholar 

  8. Dodek PM, Wong H, Heyland DK et al (2012) The relationship between organizational culture and family satisfaction in critical care. Crit Care Med 40:1506–1512. https://doi.org/10.1097/CCM.0b013e318241e368

    Article  PubMed  Google Scholar 

  9. Coleman EA, Smith JD, Frank JC et al (2004) Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention: the care transitions intervention. J Am Geriatr Soc 52:1817–1825. https://doi.org/10.1111/j.1532-5415.2004.52504.x

    Article  PubMed  Google Scholar 

  10. Lautrette A, Darmon M, Megarbane B et al (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478. https://doi.org/10.1056/NEJMoa063446

    Article  CAS  PubMed  Google Scholar 

  11. Kentish-Barnes N, Chevret S, Valade S et al (2022) A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 399:656–664. https://doi.org/10.1016/S0140-6736(21)02176-0

    Article  PubMed  Google Scholar 

  12. Carson SS, Cox CE, Wallenstein S et al (2016) Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 316:51. https://doi.org/10.1001/jama.2016.8474

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bandura A (1977) Social learning theory. Prentice Hall, Hoboken

    Google Scholar 

  14. Curtis JR, Treece PD, Nielsen EL et al (2016) Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med 193:154–162. https://doi.org/10.1164/rccm.201505-0900OC

    Article  PubMed  PubMed Central  Google Scholar 

  15. Curtis JR, Kentish-Barnes N, Brumback LC et al (2021) Facilitating communication for critically ill patients and their family members: study protocol for two randomized trials implemented in the US and France. Contemp Clin Trials 107:106465. https://doi.org/10.1016/j.cct.2021.106465

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

    Article  CAS  PubMed  Google Scholar 

  17. Bienvenu OJ, Williams JB, Yang A et al (2013) Posttraumatic stress disorder in survivors of acute lung injury: evaluating the impact of event scale-revised. Chest 144:24–31. https://doi.org/10.1378/chest.12-0908

    Article  PubMed  Google Scholar 

  18. Teno JM, Fisher ES, Hamel MB et al (2002) Medical care inconsistent with patients’ treatment goals: association with 1-year medicare resource use and survival. J Am Geriatr Soc 50:496–500. https://doi.org/10.1046/j.1532-5415.2002.50116.x

    Article  PubMed  Google Scholar 

  19. Finkelstein EA, Bilger M, Flynn TN, Malhotra C (2015) Preferences for end-of-life care among community-dwelling older adults and patients with advanced cancer: a discrete choice experiment. Health Policy 119:1482–1489. https://doi.org/10.1016/j.healthpol.2015.09.001

    Article  PubMed  Google Scholar 

  20. Steinhauser KE, Voils CI, Bosworth HB, Tulsky JA (2014) Validation of a measure of family experience of patients with serious illness: the QUAL-E (Fam). J Pain Symptom Manag 48:1168–1181. https://doi.org/10.1016/j.jpainsymman.2014.04.006

    Article  Google Scholar 

  21. White IR, Royston P, Wood AM (2011) Multiple imputation using chained equations: issues and guidance for practice. Stat Med 30:377–399. https://doi.org/10.1002/sim.4067

    Article  PubMed  Google Scholar 

  22. Howell AA, Nielsen EL, Turner AM et al (2014) Clinicians’ perceptions of the usefulness of a communication facilitator in the intensive care unit. Am J Crit Care 23:380–386. https://doi.org/10.4037/ajcc2014517

    Article  PubMed  PubMed Central  Google Scholar 

  23. Khandelwal N, Benkeser D, Coe NB et al (2016) Economic feasibility of staffing the intensive care unit with a communication facilitator. Ann Am Thorac Soc 13:2190–2196. https://doi.org/10.1513/AnnalsATS.201606-449OC

    Article  PubMed  PubMed Central  Google Scholar 

  24. White DB, Angus DC, Shields A-M et al (2018) A randomized trial of a family-support intervention in intensive care units. N Engl J Med 378:2365–2375. https://doi.org/10.1056/NEJMoa1802637

    Article  PubMed  Google Scholar 

  25. (1995) A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 274:1591–1598

  26. Curtis JR, Back AL, Ford DW et al (2013) Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. JAMA 310:2271–2281. https://doi.org/10.1001/jama.2013.282081

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Kentish-Barnes N, Chevret S, Champigneulle B et al (2017) Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial. Intensive Care Med 43:473–484. https://doi.org/10.1007/s00134-016-4669-9

    Article  PubMed  Google Scholar 

  28. Davidson J, Aslakson R, Long A et al (2017) Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 45:103–128. https://doi.org/10.1097/CCM.0000000000002169

    Article  PubMed  Google Scholar 

  29. Fassier T, Lautrette A, Ciroldi M, Azoulay E (2005) Care at the end of life in critically ill patients: the European perspective. Curr Opin Crit Care 11:616–623

    Article  PubMed  Google Scholar 

  30. Blythe JA, Kentish-Barnes N, Debue A-S et al (2022) An interprofessional process for the limitation of life-sustaining treatments at the end of life in France. J Pain Symptom Manag 63:160–170. https://doi.org/10.1016/j.jpainsymman.2021.06.016

    Article  Google Scholar 

Download references

Funding

All financial support for the research was provided by French Ministry of Health. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France

    Nancy Kentish-Barnes, Elie Azoulay, Antoine Lafarge, Virginie Souppart, Anne Renet & Frédéric Pochard

  2. Paris Cité University, Paris, France

    Elie Azoulay, Alain Cariou & Matthieu Resche-Rigon

  3. Medical Intensive Care Unit, CHU de Nantes, Nantes, France

    Jean Reignier, Pamela Clavier & Fanny Dilosquer

  4. Université de Nantes, Nantes, France

    Jean Reignier

  5. Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France

    Alain Cariou & Sébastien Légé

  6. Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France

    Olivier Huet & Thomas Gargadennec

  7. Université de Brest, Brest, France

    Olivier Huet

  8. Medical Intensive Care Unit, Brest University Hospital, Brest, France

    Anne Renault & Ludivine Leroux

  9. Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA

    Lyndia C. Brumback, Ruth A. Engelberg & J. Randall Curtis

  10. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA

    Lyndia C. Brumback, Ruth A. Engelberg & J. Randall Curtis

  11. Clinical Research Unit, APHP, Saint Louis University Hospital, Paris, France

    Matthieu Resche-Rigon

Authors
  1. Nancy Kentish-Barnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elie Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean Reignier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alain Cariou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antoine Lafarge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olivier Huet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas Gargadennec
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anne Renault
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Virginie Souppart
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pamela Clavier
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Fanny Dilosquer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ludivine Leroux
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sébastien Légé
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Anne Renet
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Lyndia C. Brumback
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Ruth A. Engelberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Frédéric Pochard
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Matthieu Resche-Rigon
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. J. Randall Curtis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JRC, NKB, RE and EA wrote the study protocol. LB and MRR designed the study, planned and did the statistical analysis. All co-authors approved the study protocol. NKB wrote the first draft of the report with input from EA, MMR, RE, LB, and FP. JR, AC, AL, OH, TG, AR, VS, PC, FD, LL, SL, and AR provided substantial contribution to the acquisition of data. EA and NKB accessed and verified the data. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Nancy Kentish-Barnes.

Ethics declarations

Conflicts of interest

NK-B reported grants from French Ministry of Health during the conduct of the study and outside the submitted work. EA reported receipt of personal fees (lectures) from Pfizer, Gilead, Baxter, and Alexion; and institutional research grants from Merck Sharp and Dohme, Pfizer, Baxter, and Alexion outside the submitted work. AC received fees for conferences from Bard, outside the submitted work. All the other Authors have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Tables (DOCX 26 KB)

134_2024_7390_MOESM2_ESM.pdf

Supplemental Fig. 1: Distribution of family interaction from randomisation to end of follow-up (x axis). Each dot corresponds to a family interaction. The total number of dots is 2246. (PDF 104 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kentish-Barnes, N., Azoulay, E., Reignier, J. et al. A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07390-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00134-024-07390-y

Keywords

Search

Navigation