Family satisfaction in the intensive care unit: what makes the difference?

Abstract

Purpose: To assess family satisfaction in the ICU and to identify parameters for improvement. Methods: Multicenter study in Swiss ICUs. Families were given a questionnaire covering overall satisfaction, satisfaction with care and satisfaction with information/decision-making. Demographic, medical and institutional data were gathered from patients, visitors and ICUs. Results: A total of 996 questionnaires from family members were analyzed. Individual questions were assessed, and summary measures (range 0-100) were calculated, with higher scores indicating greater satisfaction. Summary score was 78 ± 14 (mean ± SD) for overall satisfaction, 79 ± 14 for care and 77 ± 15 for information/decisionmaking. In multivariable multilevel linear regression analyses, higher severity of illness was associated with higher satisfaction, while a higher patient:nurse ratio and written admission/discharge criteria were associated with lower overall satisfaction. Using performanceimportance plots, items with high impact on overall satisfaction but low satisfaction were identified. They included: emotional support, providing understandable, complete, consistent information and coordination of care. Conclusions: Overall, proxies were satisfied with care and with information/decision-making. Still, several factors, such as emotional support, coordination of care and communication, are associated with poor satisfaction, suggesting the need for improvement.

Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS

“…Stricker et al 55 (in a multicentre evaluation of factors associated with family satisfaction using the German version of the FS-ICU-34 but scored using the 24 items of the FS-ICU-24) found that, among 996 family members of both ICU survivors and non-survivors in 23 ICUs, increasing acute severity of illness of the patient [evaluated using the Simplified Acute Physiology Score (SAPS) II] was associated with increasing satisfaction on the overall family satisfaction score, and lower satisfaction was associated with ICU-level characteristics of a written admission/discharge policy and a higher patient-nurse ratio. Family member characteristics of sex and relationship to the patient were included in the multivariable model but not found to be significantly associated with satisfaction.…”

“…Of the 21 studies, 16 were based on single publications from a single cohort 17,[38][39][40][41][42][55][56][57][72][73][74][75][78][79][80] and five were based on multiple publications from overlapping cohorts. 9,10,53,54,[59][60][61][62][63][64][65][66][67][68][69][70][71]76,77 These studies are reported between 2002 and 2014.…”

“…Most of the studies were based in North America -the USA (n = 9) 53,54,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][76][77][78][79][80] and Canada (n = 3) 9,10,56,74 -with other studies based in Greece (n = 2), 41,42 Switzerland (n = 2), 17,55 Germany (n = 1), 39 Israel (n = 1), 57 the Netherlands (n = 1), 75 the Philippines (n = 1) 38 and Turkey (n = 1). 40 Nine studies were single centre, with the remainder being multicentre, ranging from 2 to 23 centres.…”

Using family satisfaction data to improve the processes of care in ICU

“…Statistical expressions of association cannot do justice to the complexity of negotiating consensus with and amongst families who are engaged in end-of-life decision-making. Certainly Stricker and colleagues were limited by what they could measure in this quantitative study [4]. There are probably many more pertinent issues that were not investigated, some of which are not measurable quantitatively.…”

“…In this issue of Intensive Care Medicine, Stricker and colleagues used the FS-ICU 24 to further contribute to what is known about family satisfaction in the ICU [4]. In 2007, they distributed 1,321 questionnaires at 23 adult Swiss-German ICUs and provide here an analysis of the 996 completed questionnaires (response rate 75%).…”