The FICUS cluster randomized controlled trial of a family support intervention in adult intensive care units: mental health and family functioning outcomes

Intensive Care Medicine: Published 18 May 2026

Purpose

To examine the effect of a multicomponent, nurse-led, interprofessional family support intervention on family functioning and mental health in adult intensive care units (ICUs).

Methods

A cluster-randomized controlled trial in 16 Swiss ICUs compared an intervention—a family care pathway with specially trained ICU family nurses engaging and liaising with families, giving psychoeducational and relationship-focused care, and providing structured, interprofessional communication—to usual care. Family members of patients with an expected ICU stay of ≥ 48 h and a high risk of death, serious impairment, or prolonged mechanical ventilation participated. Outcomes included family functioning, resilience, life satisfaction, quality of life, distress, anxiety, depression, and posttraumatic stress, assessed at patient ICU admission, discharge, 3-, 6-, and 12 months post-ICU, and analyzed by linear mixed effects models.

Results

Almost half (43%) of the invited family members participated (885; May 2022 to January 2024). Follow-ups were completed on time by 736 (83.2%), 665 (75.1%), 643 (71.6%), and 593 (67.0%), respectively. Between 609 and 613 were included in the analysis. Family member characteristics were comparable at baseline, yet patient mechanical ventilation (60.3 vs. 49.5%) and ICU death (19.9 vs. 13.2%) were higher in the intervention than the control arm. There was no significant difference between the study arms for any of the outcomes. Type of relationship, prior ICU experience, and patient mechanical ventilation were associated with some of the outcomes. Mental health systematically improved post-ICU.

Conclusion

No evidence of a significant improvement in family functioning or mental health was found within the first year after ICU treatment. Due to limitations, the results of our study have to be interpreted cautiously and in a hypothesis-generating manner.

 

 Understanding and addressing a ‘difficult’ family in ICU

Critical Care volume 29, Article number: 22 (2025)

Published: 13 January 2025

 

Abstract

Conflicts between ICU staff and patient/relatives are common and are a source of additional stress in an already tense environment. These conflicts vary from disagreements to serious controversies, which may lead to legal process or even violence. Unsuccessful communication is recognised as a common denominator for such disagreements. Both conflict prevention and conflict management/resolution rely on understanding and addressing the main reasons behind it. Using a case-example, we propose a ‘mentalisation-based’ approach to family meetings may improve communication and decrease conflict.

 

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Intensive Care Med (2024). Published 03 October 2024

Abstract

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

 

A Multiple Baseline Trial of an Electronic ICU Discharge Summary Tool for Improving Quality of Care

 

by Stelfox, Henry T.; Brundin-Mather, Rebecca; Soo, Andrea; Whalen-Browne, Liam; Kashyap, Devika; Sauro, Khara M.; Bagshaw, Sean M.; Fiest, Kirsten M.; Taljaard, Monica; Parsons Leigh, Jeanna 

 

Critical Care Medicine: August 16, 2022 - Volume - Issue - 10.1097

 

Objective: 

Effective communication between clinicians is essential for seamless discharge of patients between care settings. Yet, discharge summaries are commonly not available and incomplete. We implemented and evaluated a structured electronic health record–embedded electronic discharge (eDischarge) summary tool for patients discharged from the ICU to a hospital ward.

Design: 

Multiple baseline trial with randomized and staggered implementation.

Setting: 

Adult medical-surgical ICUs at four acute care hospitals serving a single Canadian city.

Patients: 

Health records of patients 18 years old or older, in the ICU 24 hours or longer, and discharged from the ICU to an in-hospital patient ward between February 12, 2018, and June 30, 2019.

Intervention: 

A structured electronic note (ICU eDischarge tool) with predefined fields (e.g., diagnosis) embedded in the hospital-wide electronic health information system.

MEASUREMENTS AND MAIN RESULTS 

: We compared the percent of timely (available at discharge) and complete (included goals of care designation, diagnosis, list of active issues, active medications) discharge summaries pre and post implementation using mixed effects logistic regression models. After implementing the ICU eDischarge tool, there was an immediate and sustained increase in the proportion of patients discharged from ICU with timely and complete discharge summaries from 10.8% (preimplementation period) to 71.1% (postimplementation period) (adjusted odds ratio, 32.43; 95% CI, 18.22–57.73). No significant changes were observed in rapid response activation, cardiopulmonary arrest, death in hospital, ICU readmission, and hospital length of stay following ICU discharge. Preventable (60.1 vs 5.7 per 1,000 d; p = 0.023), but not nonpreventable (27.3 vs 40.2 per 1,000d; p = 0.54), adverse events decreased post implementation. Clinicians perceived the eDischarge tool to produce a higher quality discharge process.

Conclusions: 

Implementation of an electronic tool was associated with more timely and complete discharge summaries for patients discharged from the ICU to a hospital ward.

 

 

The communication experience of tracheostomy patients with nurses in the intensive care unit: A phenomenological study

The communication experience of tracheostomy patients with nurses in the intensive care unit: A phenomenological study

by Angela Tolotti, Annamaria Bagnasco, Gianluca Catania, Giuseppe Aleo, Nicola Pagnucci, Lucia Cadorin, Milko Zanini, Gennaro Rocco, Alessandro Stievano, Franco A. Carnevale, Loredana Sasso  

Intensive Critical Care Nursing – In press

Abstract

Objectives

To describe the experience and sources of comfort and discomfort in tracheostomy patients, when they communicate with nurses in the Intensive Care Unit.

Research methodology/design

Benner’s interpretive phenomenology. Data were collected through: a) semi-structured interviews conducted with the patients after leaving the intensive care unit; b) participant observation; c) situated interviews with intensive care nurses.

Setting

The intensive care unit of a hospital in Northern Italy.

Findings

Eight patients and seven nurses were included in this study. Two main themes were identified 1) feeling powerless and frustrated due to the impossibility to use voice to communicate; 2) facing continual misunderstanding, resignation, and anger during moments of difficulty and/or communication misunderstandings. The main communication discomfort factors were: struggling with not knowing what was happening, feeling like others had given up on me, living in isolation and feeling invisible. The main comfort factors were: being with family members, feeling reassured by having a call bell nearby and nurses' presence.

Conclusions

This study highlights the important role of communication in tracheostomy patients in intensive care and how closely it is linked to all the aspects of a person’s life, which cannot be underestimated as just not being able to use one’s voice.

The experience of communication difficulties in critically ill patients in and beyond intensive care

The experience of communication difficulties in critically ill patients in and beyond intensive care: findings from a larger phenomenological study. Intensive and Critical Care Nursing, Dec. 2014 [in press].

Tembo, A.C., et al.

http://www.intensivecriticalcarenursing.com/article/S0964-3397(14)00091-3/abstract?rss=yes

Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption 

Nurses' perceptions of communications training in the ICU

Nurses' perceptions of communications training in the ICU. Intensive and critical care nursing, 2012, 28, p.16-25.

Radtke, J.V., et al.

http://download.journals.elsevierhealth.com/pdfs/journals/0964-3397/PIIS0964339711001248.pdf

As a direct result of critical illness and its management, ICU patients and their caregivers are vulnerable to communication breakdown and associated adverse sequelae. Nurses are the most frequent communication partners to critically ill patients during the period in which they are unable to speak. However, nurses do not typically receive training in specialised communication assessment or techniques to use with nonspeaking patients.

AMERICAN JOURNAL OF CRITICAL CARE
VOL 18; NUMB 1; 2009
ISSN 1062-3264

pp. 21-30
Intensive Care Units, Communication Between Nurses and Physicians, and Patients' Outcomes.
Manojlovich, M.; Antonakos, C.L.; Ronis, D.L.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN243791960&field=zid

Management of Communication and Swallowing in Intensive Care: The Role of the Speech Pathologist.

AACN
pp. 433-443
Baumgartner, C.A.; Bewyer, E.; Bruner, D.
http://zetoc.mimas.ac.uk/wzgw?db=etoc&terms=RN239723561&field=zid