Decision Support Tool for ICU Patients' Families

Families of intensive care unit (ICU) patients perceive severe deficiencies in communication about decision making. A new study finds that an online decision support tool is an acceptable and valuable tool as perceived by the family members of critically ill patients. The findings are reported in Journal of Critical Care.

Critically ill, mechanically ventilated patients are frequently unable to participate in clinical decision making, such that family members often become substitute decision makers (SDMs). However, these family members may not fully understand how best to function in this role, may not fully grasp the information presented to them by clinicians, and/or may struggle with making end-of-life decisions.

There have been few interventions designed to foster shared decision making in the ICU. Strategies that engage and educate family members in shared decision making and help them perform their roles as SDMs represent a novel, untapped approach to improving care.

This multicentre study sought to test the feasibility, clinical utility, and acceptability of a decision-making support tool with family members of critically ill patients to promote patient- and family-centred care. MyICUGuide is a family-facing intervention to empower and capacitate family members during shared decision making. The tool, which is written at an eighth grade reading level, was developed from 19 qualitative interviews of family members' perceived stressors and coping strategies used during the decision-making process.

The study, conducted at two university medical ICUs, enrolled 27 families of patients with critical illness. Eligible participants were approached within 48 hours of the ICU stay and invited to participate in a study that involved reviewing a paper or online version of the decision-support intervention and participating in a 1- to 2-hour semi-structured interview about their experiences using the tool.

All participants (100 percent) rated MyICUGuide positively, and 93 percent would recommend the decision-support tool to others.

"This multisite feasibility study demonstrates that family members of patients with critical illness found MyICUGuide to be a clear, easily understandable tool that provided an adequate amount of information regarding the ICU and the surrogate decision-making process. Although minor changes to the content and wording were suggested, the vast majority of subjects would recommend the tool to other ICU families," the authors note.

Source: Journal of Critical Care
Image Credit: Pixabay