Improving partnerships with family members of ICU patients: study protocol for a randomized controlled trial

Abstract

BackgroundOver the last decade, health care delivery has shifted to partnering with patients and their families to improve health and quality of care, and to lower costs. Partnering with family members (FMs) of critically ill patients who lack capacity is particularly important for improving experiences and outcomes for both patients and FMs. How best to apply such partnering strategies, however, is yet unknown. The IMPACT trial will evaluate two interventions that enable partnerships with families of critically ill patients, each in a distinct content area, but similar in that they empower and support FMs.MethodsThis multi-center, open-label, randomized, phase II clinical trial aims to randomize 150 older, long-stay ICU patients and their families into one of three groups (50 in each group): (1) The OPTimal nutrition by Informing and Capacitating FMs of best practices (OPTICs) group, a multi-faceted intervention to engage and empower FMs to advocate for, and audit, best nutritional practices for their critically ill FMs, (2) A web-based decision-support intervention called the ICU Workbook (The Canadian Researchers at the End of Life Network (CARENET) ICU Workbook; https://www.myicuguide.ca/. Accessed 3 Feb 2017.) to support families in shared decision-making process regarding goals of medical treatments, and (3) Usual care. The main outcomes for this trial include nutritional adequacy in hospital and hand-grip strength prior to hospital discharge; satisfaction with decision-making; decision conflict; and degree of shared decision-making.DiscussionWith the goal of improving the functional recovery of nutritionally high-risk older patients and the quality of care at the end of life for these patients and their FMs in the ICU, we have proposed two novel family capacitation strategies. We hope that the nutrition and decision-support interventions implemented and evaluated in our study will contribute to the evidentiary basis for best family partnered care pathways focused on optimizing the quality of ICU care for patients with life-threatening illness and their families.Trial registrationClinical trials.gov, ID: NCT02920086. Registered on 30 September 2016. Protocol version dated 11 October 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2379-4) contains supplementary material, which is available to authorized users.

Patient and family engagement in the ICU: Report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine

“…Ultimately, improving partnerships with families can help to optimize the quality of ICU care for both patients with lifethreatening illness and their family members. 29,30…”

A phenomenological study on the lived experiences of families of ICU patients, Addis Ababa, Ethiopia

“…Intensive care unit (ICU) is one of the wards in hospitals where critical care service is given. Families of ICU patients are the source of information including past medical history of the patient [8]. They also do shared decision makings, pay the medical bills, function as a legal representation to give consent and respect patient rights, and do the routine care for the other affected family members of the patient at home [2,8].…”

Persistence of patient and family experiences of critical illness

“…A greater understanding of patient and family past experiences and how that might shape expectations can create a framework for communication going forward, which is critical to partnerships among patients and family and the medical system. 34 We found that culture and trust influence effective medical partnerships and decision making, thereby shaping experiences. 35 In our study and work by others', cultural influences appeared to span beyond simple failures of communication, as people of different cultural groups often had different community structures and expectations.…”