Effects of a structured communication strategy on anxiety, uncertainty and satisfaction with care in families of critically ill adults

Abstract

Effects of a structured communication strategy on anxiety, uncertainty and satisfaction with care in families of critically ill adults Pamela Scott ABSTRACT Background: The sudden and unanticipated admission of a relative to the intensive care unit (ICU) is both a frightening and stressful event for their families. Family members are affected both physically and psychologically by their experience of having a relative admitted to ICU. Clinical practice guidelines recommend that high-quality care requires focussing on the family, identifying their needs, understanding their experience and implementing effective interventions for supporting them throughout their relative’s critical illness. Communication with ICU staff and families has been identified as one of their most important needs. Inadequate, inconsistent and poor-quality communication has been consistently associated with psychological distress and dissatisfaction with care and decision-making in families of critically ill adults. Aim: The aim of the study was to evaluate the effects of delivering a structured communication strategy on anxiety (state and trait), levels of uncertainty, and satisfaction overall with care and decision-making in families of critically ill patients who survive ICU. Two research questions were identified to address this aim: • In family members of ICU patients, how did the control group and intervention group’s state and trait anxiety, uncertainty in illness, and satisfaction overall with care and information/decision-making, change from relative’s admission to ICU to discharge from ICU? • What effect did the introduction of the intervention (i.e., communication strategy) have over time on the intervention group compared to control group ICU family members state and trait anxiety, uncertainty in illness, satisfaction overall with care and with information/decision-making (time x group effect)? Methods: This was a quasi-experimental study with a pre-and post-test non-equivalent control group design. Family members in the intervention group (n=26) received both oral and printed information to guide them in preparing for a structured family meeting. The family members allocated to the control group (n=26) received usual routine care, and experienced the existing family informational support already operational in the study site ICU. State and trait anxiety, uncertainty, family satisfaction scores overall with care and information/ decision-making, were measured in the two groups within 48 hours of ICU admission, and prior to ICU discharge. Results: Following the intervention, the experimental group reported lower state anxiety and uncertainty scores, but these failed to reach a level of significance (p>0.05). Both groups of family members were highly satisfied overall and with care in the ICU (>80%). Families were mostly, rather than highly, satisfied with information and decision-making (73% versus 71%). From the three free-text responses introduced on the FS ICU questionnaire, family members reported the largest number of negative comments for frequency of communication with medical staff and the ICU waiting room. Conclusion: Structured oral and written communication reduced anxiety levels in families of patients admitted to the ICU, although this reduction was not significant or exclusive to the intervention group. Uncertainty levels reduced in those receiving the intervention, this reduction was not seen in the control group. Families were highly satisfied overall, but improvements could be made with the frequency of communication with medical staff and inclusion and support in the decision-making process. More studies are needed into the effectiveness of interventions in ICU, and their core components to help improve family members’ satisfaction with care, and their psychological health and well-being. Intensive care units that are able to support interventions based on meeting family information needs, in addition to reducing psychological burden and dissatisfaction, will enable each family to provide more support to their relative within the ICU.