• Nancy Kentish-Barnes, Elie Azoulay, Jean Reignier, Alain Cariou, Antoine Lafarge, Olivier Huet, Thomas Gargadennec, Anne Renault, Virginie Souppart, Pamela Clavier, Fanny Dilosquer, Ludivine Leroux, Sébastien Légé, Anne Renet, Lyndia C Brumback, Ruth A Engelberg, Frédéric Pochard, Matthieu Resche-Rigon, and CurtisJ RandallJRCambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA..
• Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France. nancy.kentish@aphp.fr.
• Intensive Care Med. 2024 Apr 4.

PurposeSuboptimal 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.MethodsWe 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).Results385 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.ConclusionThis study does not support the use of facilitators for family members of ICU patients.© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

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