Family members of critically ill adults admitted to intensive care units can face sudden disruption, high burden and persistent psychological symptoms after the ICU stay. The FICUS intervention tested whether structured nurse-led family support could improve family functioning and mental health through a care pathway built around family engagement, psychoeducation, relationship-focused support and interprofessional communication. A cluster-randomised controlled trial published in Intensive Care Medicine evaluated the pathway across 16 Swiss adult ICUs against usual care. Family members of patients expected to remain in ICU for at least 48 hours, with high risk of death, serious impairment or prolonged mechanical ventilation, joined the evaluation. The intervention increased family care quality measures but did not produce significant improvements in family functioning or mental health over one year.
Family Pathway Targets ICU Communication
Family members of adults admitted to ICU for critical illness or trauma often face abrupt disruption, high burden and mental health risks. Postintensive Care Syndrome-Family covers symptoms including anxiety, depression, posttraumatic stress or prolonged grief, affecting 20–40% of family members of critically ill adults. Personal risk factors include pre-existing mental illness and female gender, while care-related factors include dissatisfaction with care and poor communication.
FICUS used a family systems care approach and combined three core elements. ICU family nurses built, maintained and concluded relationships with families, supported interactions between families and ICU teams and helped coordinate referrals or transitions. They assessed family structure, functioning, needs and preferences, provided psychoeducation and offered emotional, cognitive, behavioural and relationship-focused support. Interprofessional family meetings gave families space for concerns and questions, information on the patient’s situation, discussion of treatment options and shared decision-making.
The pathway began at ICU admission and continued into the post-ICU phase, with at least one contact around four weeks after ICU discharge. Two to three ICU-certified nurses per intervention ICU assumed the family nurse role and received five days of training, followed by monthly case conferences and two refresher days. Usual care covered non-standardised family care practices already in place before FICUS, including visitation, information provision and communication.
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Large Swiss Sample Shows Comparable Family Baselines
FICUS enrolled 885 family members between May 2022 and January 2024, representing 42.7% of those invited. Follow-up completion remained substantial, with 83.2% completing the ICU discharge assessment on time and 67.0% completing the 12-month follow-up. Between 609 and 613 participants entered the main adjusted analyses, depending on the outcome.
Family member characteristics were similar at baseline. The median age was in the mid-fifties in both arms and most participating family members were female. Spouses or partners formed the largest relationship group, followed by adult children and parents. Prior ICU experience included experience as a patient, as a family member of a patient or both.
Patient characteristics differed between arms. The intervention arm had fewer unplanned ICU admissions, more frequent mechanical ventilation, a slightly longer ICU stay and more ICU deaths. Patient age and severity scores were broadly similar. Baseline family functioning, resilience, life satisfaction, quality of life, distress, anxiety, depression and posttraumatic stress measures were comparable across arms.
The intervention reached families through 22 ICU-certified family nurses with long median work experience. Support involved one family member in just over half of cases, while other sessions involved several family members or wider team delivery. Combined fidelity to all pathway components within the predefined timing reached 23.1% of cases.
Mental Health Improves Without Intervention Effect
At six months, intervention and control arms did not differ significantly for family functioning, resilience, life satisfaction, quality of life, distress, anxiety, depression or posttraumatic stress. Multiple imputation gave similar results, apart from a negative intervention effect on life satisfaction. Average effects over the full follow-up also remained non-significant.
Outcomes changed over time for family members in both arms. Family functioning slightly deteriorated between ICU discharge and six months. Life satisfaction did not change significantly up to six months but increased later. Quality of life improved from ICU discharge to six months and continued to improve between six and 12 months. Distress, anxiety and depression fell over six months and declined further afterwards.
Several characteristics related to outcomes without changing intervention effectiveness. Mechanical ventilation at ICU admission related to higher anxiety and lower quality of life among family members. Spouses or partners had lower life satisfaction and quality of life than some other relationship groups and higher anxiety and depression in several comparisons. Prior ICU experience as a patient related to higher resilience and higher depression.
Interpretation remains cautious because FICUS included few ICU clusters, baseline differences between arms and substantial missing baseline outcome data. Combined fidelity to the full intervention timeline and minimum dose was low. Socially disadvantaged families, non-German-speaking families and highly burdened families may also have been underrepresented.
FICUS shows that a nurse-led, interprofessional family support pathway can improve aspects of family care and communication without demonstrating measurable gains in family functioning or mental health during the first year after ICU treatment. Mental health symptoms declined over time in both arms, while relationship to the patient, prior ICU experience and mechanical ventilation related to several outcomes. The results support careful interpretation of nurse-led ICU family pathways and a continued focus on tailoring support to family context, illness trajectory and post-ICU needs.
Source: Intensive Care Medicine
Image Credit: iStock
References:
Riguzzi M, Jeitziner MM, Rufer M et al. (2026) The FICUS cluster randomized controlled trial of a family support intervention in adult intensive care units: mental health and family functioning outcomes. Intensive Care Med; 52: 637–650.
