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      Family members' satisfaction with care and decision‐making in intensive care units and post‐stay follow‐up needs—a cross‐sectional survey study

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          Abstract

          Aim

          The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death.

          Design

          A cross‐sectional survey study was conducted.

          Methods

          Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU ( FS‐ ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis.

          Results

          A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.

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          Risk of post-traumatic stress symptoms in family members of intensive care unit patients.

          Elie Azoulay, Frédéric Pochard, Nancy Kentish-Barnes … (2005)
          Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD). Factors associated with these symptoms need to be identified. For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role. Ninety days after ICU discharge or death, family members completed the Impact of Event Scale (which evaluates the severity of post-traumatic stress reactions), Hospital Anxiety and Depression Scale, and 36-item Short-Form General Health Survey during a telephone interview. Linear regression was used to identify factors associated with the risk of post-traumatic stress symptoms. Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Post-traumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe post-traumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life. Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.
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            Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity.

            E Azoulay, P Canouï, Andrew J. Gall … (2001)
            Anxiety and depression may have a major impact on a person's ability to make decisions. Characterization of symptoms that reflect anxiety and depression in family members visiting intensive care patients should be of major relevance to the ethics of involving family members in decision-making, particularly about end-of-life issues. Prospective multicenter study. Forty-three French intensive care units (37 adult and six pediatric); each unit included 15 patients admitted for longer than 2 days. Six hundred thirty-seven patients and 920 family members. Intensive care unit characteristics and data on the patient and family members were collected. Family members completed the Hospital Anxiety and Depression Scale to allow evaluation of the prevalence and potential factors associated with symptoms of anxiety and depression. Of 920 Hospital Anxiety and Depression Scale questionnaires that were completed by family members, all items were completed in 836 questionnaires, which formed the basis for this study. The prevalence of symptoms of anxiety and depression in family members was 69.1% and 35.4%, respectively. Symptoms of anxiety or depression were present in 72.7% of family members and 84% of spouses. Factors associated with symptoms of anxiety in a multivariate model included patient-related factors (absence of chronic disease), family-related factors (spouse, female gender, desire for professional psychological help, help being received by general practitioner), and caregiver-related factors (absence of regular physician and nurse meetings, absence of a room used only for meetings with family members). The multivariate model also identified three groups of factors associated with symptoms of depression: patient-related (age), family-related (spouse, female gender, not of French descent), and caregiver-related (no waiting room, perceived contradictions in the information provided by caregivers). More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.
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              Posttraumatic stress and complicated grief in family members of patients in the intensive care unit.

              Richard G. W. Anderson, C Bryce, Jayanth R Arnold … (2008)
              Family members of patients in intensive care units (ICUs) are at risk for mental health morbidity both during and after a patient's ICU stay. To determine prevalences of and factors associated with anxiety, depression, posttraumatic stress and complicated grief in family members of ICU patients. Prospective, longitudinal cohort study. Fifty family members of patients in ICUs at a large university hospital participated. We used the Control Preferences Scale to determine participants' role preferences for surrogate decision-making. We used the Hospital Anxiety and Depression Scale, Impact of Event Scale, and Inventory of Complicated Grief to measure anxiety and depression (at enrollment, 1 month, 6 months), posttraumatic stress (6 months), and complicated grief (6 months). We interviewed all 50 participants at enrollment, 39 (78%) at 1 month, and 34 (68%) at 6 months. At the three time points, anxiety was present in 42% (95% CI, 29-56%), 21% (95% CI, 10-35%), and 15% (95% CI, 6-29%) of participants. Depression was present in 16% (95% CI, 8-28%), 8% (95% CI, 2-19%), and 6% (95% CI, 1-18%). At 6 months, 35% (95% CI, 21-52%) of participants had posttraumatic stress. Of the 38% who were bereaved, 46% (95% CI, 22-71%) had complicated grief. Posttraumatic stress was not more common in bereaved than nonbereaved participants, and neither posttraumatic stress nor complicated grief was associated with decision-making role preference or with anxiety or depression during the patient's ICU stay. Symptoms of anxiety and depression diminished over time, but both bereaved and nonbereaved participants had high rates of posttraumatic stress and complicated grief. Family members should be assessed for posttraumatic stress and complicated grief.
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                Author and article information

                Contributors
                Gro Frivold:
                ORCID: http://orcid.org/0000-0002-6041-1819
                gro.frivold@uia.no
                Journal
                Journal ID (nlm-ta): Nurs Open
                Journal ID (iso-abbrev): Nurs Open
                Journal ID (doi): 10.1002/(ISSN)2054-1058
                Journal ID (publisher-id): NOP2
                Title: Nursing Open
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2054-1058
                Publication date (Electronic): 18 October 2017
                Publication date Collection: January 2018
                Volume: 5
                Issue: 1 ( doiID: 10.1111/nop2.2018.5.issue-1 )
                Pages: 6-14
                Affiliations
                [ 1 ] University of Agder Faculty of Health and Sport Sciences Grimstad Norway
                [ 2 ] Clinical Evaluation Research Unit Kingston General Hospital Kingston ON Canada
                [ 3 ] The Canadian Researchers at the End of Life Network Kingston ON Canada
                [ 4 ] Critical Care Nutrition Department of Critical Care Medicine Queen's University Kingston ON Canada
                [ 5 ] Centre for Caring Research Southern Norway Grimstad Norway
                Author notes
                [*] [* ] Correspondence

                Gro Frivold, University of Agder, Faculty of Health and Sport Sciences, Grimstad, Norway.

                Email: gro.frivold@ 123456uia.no

                Author information
                http://orcid.org/0000-0002-6041-1819
                Article
                Publisher ID: NOP297
                DOI: 10.1002/nop2.97
                PMC ID: 5762765
                PubMed ID: 29344389
                SO-VID: 440a5768-90f5-4a44-afba-108a911540b7
                Copyright © © 2017 The Authors. Nursing Open published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 August 2016
                Date accepted : 22 August 2017
                Page count
                Figures: 0, Tables: 4, Pages: 9, Words: 8400
                Categories
                Subject: Research Article
                Subject: Research Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id nop297
                cover-date January 2018
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.8 mode:remove_FC converted:10.01.2018

                Keywords: communication,decision‐making,family satisfaction,follow‐up,intensive care,survey study
                Data availability:
                Keywords: communication, decision‐making, family satisfaction, follow‐up, intensive care, survey study

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