Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU
Open accessAbstract
Objective: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development. Results: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice. Conclusions: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.
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Four systematic reviews reported mixed findings regarding the impact of advance directives on the documentation of patient's wishes about treatment escalation and resuscitation decision-making.
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From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [14]
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Self-citation
- Authors
- Davidson, J. E., Aslakson, R. A., Long, A. C., Puntillo, K. A., Kross, E. K., Hart, J., Cox, C. E., Wunsch, H., Wickline, M. A., Nunnally, M. E., Netzer, G., Kentish-Barnes, N., Sprung, C. L., Hartog, C. S., Coombs, M., Gerritsen, R. T., Hopkins, R. O., Franck, L. S., Skrobik, Y., Kon, A. A., Scruth, E. A., Harvey, M. A., Lewis-Newby, M., White, D. B., Swoboda, S. M., Cooke, C. R., Levy, M. M., Azoulay, E., & Curtis, J. R.
- Affiliations
- UC San Diego Health System (US)
- Johns Hopkins University (US)
- University of Washington (US)
- University of California, San Francisco (US)
- University of Pennsylvania (US)
- Duke University (US)
- Sunnybrook Health Science Centre (CA)
- Johns Hopkins Medicine (US)
- University of Maryland, Baltimore (US)
- Famiréa Research Group, Medical Intensive Care, Hôpital Saint Louis, Paris, France.
- Jena University Hospital (DE)
- Victoria University of Wellington (NZ)
- Naval Medical Center San Diego (US)
- Kaiser Permanente (US)
- Divisions of Pediatric Cardiac Critical Care Medicine and Pediatric Bioethics, Department of Pediatrics, University of Washington, Seattle Childrens Hospital, Seattle, WA.
- Division of Pulmonary and Critical Care Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
- ORCID
- Davidson, Judy E.
- Aslakson, Rebecca A.
- Puntillo, Kathleen A.
- Kross, Erin K.
- Hart, Joanna
- Cox, Christopher E.
- Wunsch, Hannah
- Wickline, Mary A.
- Nunnally, Mark E.
- Sprung, Charles L.
- Hartog, Christiane S.
- Coombs, Maureen
- Gerritsen, Rik T.
- Franck, Linda S.
- Skrobik, Yoanna
- Kon, Alexander A.
- Scruth, Elizabeth A.
- White, Douglas B.
- Swoboda, Sandra M.
- Cooke, Colin R.
- Levy, Mitchell M.
- Curtis, J. Randall
- Venue
- Critical Care Medicine
- Published
- 2017-01
- Volume
- 45
- Issue
- 1
- Pages
- 103-128
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2560860516
- Cited by
- 1,540
- References
- 13
- Citations by year
- 2026: 159 · 2025: 168 · 2024: 171 · 2023: 159 · 2022: 209 · 2021: 203 · 2020: 188 · 2019: 121 · 2018: 106 · 2017: 52
- FWCI
- 155.09
- Type
- journal article
- Language
- en
- Open access
- green
- pearl.plymouth.ac.uk
- Licence
- other-oa
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PEARL (University of Plymouth) (submittedVersion, other-oa)
- eScholarship (California Digital Library) (submittedVersion)
- PEARL (University of Plymouth) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- family-centered care, intensive care unit, family support, family communication, family presence, family support services, patient-centered care, neonatal intensive care unit, pediatric intensive care unit, adult intensive care unit
- MeSH terms
- Family Relations, Humans, Intensive Care Units, Professional-Family Relations, Patient-Centered Care
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