Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory

Osborn, Tristan R.; Curtis, J. Randall; Nielsen, Elizabeth; Back, Anthony L.; Shannon, Sarah E.; Engelberg, Ruth A.

doi:10.1378/chest.11-3277

Cited by 54 publications

(62 citation statements)

References 42 publications

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“…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.…”

Section: Settingmentioning

confidence: 99%

“…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.…”

Section: Settingmentioning

confidence: 99%

“…The remaining 10 publications fell into two distinct surveyed groups: all family members of patients staying ≥ 48 hours in ICU; 39,40,57,74 and legal or nominated next of kin of ICU non-survivors. 53,62,66,67,69,70 Data from patients and family members in the FREE study meeting these eligibility criteria were extracted to facilitate comparison of the scores between the FREE study and the 10 publications. Of these 10 publications, one reported only the domain scores 74 and two reported only the overall family satisfaction score.…”

Section: Satisfaction Scoresmentioning

confidence: 99%

“…Curtis et al 2011 66 Osborn et al 2012 67 Kross et al 2012 68 DeCato et al 2013 69 Kross et al 2014 70 Long et al a They used data from only two of the six ICUs from the same cohort of data.…”

mentioning

confidence: 99%

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

Wright

Walmsley

Harvey

et al. 2015

Health Serv Deliv Res

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BackgroundTo improve care it is necessary to feed back experiences of those receiving care. Of patients admitted to intensive care units (ICUs), approximately one-quarter die, and few survivors recollect their experiences, so family members have a vital role. The most widely validated tool to seek their views is the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU).ObjectivesTo test face and content validity and comprehensibility of the FS-ICU (phase 1). To establish internal consistency, construct validity and reliability of the FS-ICU; to describe family satisfaction and explore how it varies by family member, patient, unit/hospital and other contextual factors and by country; and to model approaches to sampling for future use in quality improvement (phase 2).DesignMixed methods: qualitative study (phase 1) and cohort study (phase 2).SettingNHS ICUs (n = 2, phase 1;n = 20, phase 2).ParticipantsHealth-care professionals, ex-patients, family members of ICU patients (n = 41, phase 1). Family members of ICU patients (n = 12,303, phase 2).InterventionsNone.Main outcome measuresKey themes regarding each item of the 24-item FS-ICU (FS-ICU-24) (phase 1). Overall family satisfaction and domain scores of the FS-ICU-24 (phase 2).ResultsIn phase 1, face validity, content validity and comprehensibility were good. Adaptation to the UK required only minor edits. In phase 2, one to four family members were recruited for 60.6% of 10,530 patients (staying in ICU for 24 hours or more). Of 12,303 family members, 7173 (58.3%) completed the questionnaire. Psychometric assessment of the questionnaire established high internal consistency and criterion validity. Exploratory factor analysis indicated new domains:satisfaction with care,satisfaction with informationandsatisfaction with the decision-making process. All scores were high with skewed distributions towards more positive scores. For family members of ICU survivors, factors associated with increased/decreased satisfaction were age, ethnicity, relationship to patient, and visit frequency, and patient factors were acute severity of illness and invasive ventilation. For family members of ICU non-survivors, average satisfaction was higher but no family member factors were associated with increased/decreased satisfaction; patient factors were age, acute severity of illness and duration of stay. Neither ICU/hospital factors nor seasonality were associated. Funnel plots confirmed significant variation in family satisfaction across ICUs. Adjusting for family member and patient characteristics reduced variation, resulting in fewer ICUs identified as potential outliers. Simulations suggested that family satisfaction surveys using short recruitment windows can produce relatively unbiased estimates of average family satisfaction.ConclusionsThe Family-Reported Experiences Evaluation study has provided a UK-adapted, psychometrically valid questionnaire for overall family satisfaction and three domains. The large sample size allowed for robust multilevel multivariable modelling of factors associated with family satisfaction to inform important adjustment of any future evaluation.LimitationsResponses to three free-text questions indicate the questionnaire may not be sensitive to all aspects of family satisfaction.Future workReservations remain about the current questionnaire. While formal analysis of the free-text questions did not form part of this proposal, brief analysis suggested considerable scope for improvement of the FS-ICU-24.Study registrationCurrent Controlled Trials ISRCTN47363549.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.

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“…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.…”

Section: Settingmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Section: Satisfaction Scoresmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Wright

Walmsley

Harvey

et al. 2015

Health Serv Deliv Res

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“…Family satisfaction was measured by the FS-ICU [2][3][4], a much used and previously validated tool, while patient satisfaction was elicited by using an adapted version of this questionnaire. A similar approach has been taken previously by a Swiss group [5].…”

mentioning

confidence: 99%

Family-centered ICU care may be good for everyone

Hartog

Jensen

2013

Intensive Care Med

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In this issue of ICM, Irene Jongerden and her colleagues [1] present the results of a before-and-after study that explores the effect of a change in ICU environment on family and patient satisfaction. Family satisfaction was measured by the FS-ICU [2-4], a much used and previously validated tool, while patient satisfaction was elicited by using an adapted version of this questionnaire. A similar approach has been taken previously by a Swiss group [5]. The structural intervention was a move of the ICU to new premises, which entailed a bundle of changes. New rooms were single-bed rooms, noise-reduced, with increased privacy, more space around each bed, natural lighting and windows with a view. There were also changes in workflow, visual display of other patients via the bedside monitor, and medication prepared in a satellite pharmacy, thereby reducing medication errors. In addition, the number of family rooms was increased, and facilities for families were improved. In association with these changes, both overall family and patient satisfaction increased significantly. This study is important for several reasons: It is one of the first to show improvement in family satisfaction with an intervention (suggesting responsiveness to change), and it is one of the first that documents an effect of changing the ICU environment on families. Interestingly, satisfaction of families and patients increased not only in relation to the ICU environment, but to the ICU experience, specifically staff behavior toward families and patients. In the new ICU, families stated that staff provided better emotional support, acted with more courtesy, respect, and compassion, and were more willing to answer questions. Patients found that staff treated them with more courtesy, compassion, and respect, individual staff members were better recognizable, and management of pain improved (Fig. 1). These findings suggest that structural changes may have indirectly affected ICU care by improvement of team collaboration and support of family-and patient-centered behavior. Possibly working conditions were made easier for staff by providing more space around the bed and improving workflow. Reducing noise levels may also lower stress for nurses and physicians. It may also be easier for staff to provide emotional support to patients and families who are well satisfied with the environment. Alternatively, it is also possible that the improved environment influenced patient and family perceptions of these other aspects of care through a ''halo effect '' [6]. Nonetheless, these evaluations of diverse aspects of care improved.Defining indicators to improve quality of care for critically ill patients is an important issue [7]. Increasingly, family satisfaction with care is becoming an accepted measure of quality of care [8], and measurement of family or patient satisfaction in the ICU is already recognized as a quality indicator in several countries, including the Netherlands [9]. The study by Jongerden et al. provides further data to support that family-and p...

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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

et al. 2017

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AimThe 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.DesignA cross‐sectional survey study was conducted.MethodsFamily 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.ResultsA 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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Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory

Cited by 54 publications

References 42 publications

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

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

Family-centered ICU care may be good for everyone

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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