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The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates
Alexia M Torke1, Lucia D Wocial2, Shelley A Johns2
1Alexia M. Torke is a scientist, Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc, an associate professor, IU School of Medicine, fellowship director, Charles Warren Fairbanks Center for Medical Ethics (FCME), IU Health, and a core faculty, IU Purdue University Indianapolis (IUPUI) Research in Palliative and End of Life Communication and Training (RESPECT) Center, Indianapolis, Indiana. Lucia D. Wocial is a nurse ethicist, FCME, IU Health, a core faculty, IUPUI RESPECT Center, and an adjunct assistant professor, IU School of Nursing, Indianapolis, Indiana. Shelley A. Johns is an assistant professor, IU School of Medicine, an affiliate faculty, FCME, IU Health, a core faculty, IUPUI RESPECT Center, and a scientist, Regenstrief Institute, Inc. Greg A. Sachs is a scientist, IU Center for Aging Research, Regenstrief Institute, Inc, chief, Division of General Internal Medicine and Geriatrics, IU School of Medicine, and co-director, IUPUI RESPECT Center. Christopher M. Callahan is a scientist, IU Center for Aging Research, Regenstrief Institute, Inc, and a professor of medicine, IU School of Medicine. Gabriel T. Bosslet is an assistant professor of clinical medicine, IU School of Medicine, an affiliate faculty, FCME, IU Health, and a core faculty, IUPUI RESPECT Center. James E. Slaven is a biostatistician, Department of Biostatistics, IU School of Medicine. Susan M. Perkins is a core faculty, IUPUI RESPECT Center and a professor, Department of Biostatistics, IU School of Medicine. Susan E. Hickman is a senior affiliate faculty, FCME, IU Health, co-director, IUPUI RESPECT Center, and a professor, IU School of Nursing. Kianna Montz is a research coordinator and Emily Burke is a research specialist, IU Center for Aging Research, Regenstrief Institute, Inc. atorke@iu.edu.
Background:
Communication problems between family surrogates and intensive care unit (ICU) clinicians have been documented, but few interventions are effective. Nurses have the potential to play an expanded role in ICU communication and decision making.
Objectives:
To conduct a pilot randomized controlled trial of the family navigator (FN), a distinct nursing role to address family members' unmet communication needs early in an ICU stay.
Methods:
An interprofessional team developed the FN protocol. A randomized controlled pilot intervention trial of the FN was performed in a tertiary referral hospital's ICU to test the feasibility and acceptability of the intervention. The intervention addressed informational and emotional communication needs through daily contact by using structured clinical updates, emotional and informational support modules, family meeting support, and follow-up phone calls.
Results:
Twenty-six surrogate/patient pairs (13 per study arm) were enrolled. Surrogates randomized to the intervention had contact with the FN on 90% or more of eligible patient days. All surrogates agreed that they would recom mend the FN to other families. Open-ended comments from both surrogates and clinicians were uniformly positive.
Conclusions:
Having a fully integrated nurse empowered to facilitate decision making is a feasible intervention in an ICU and is well-received by ICU families and staff. A larger randomized controlled trial is needed to demonstrate impact on important outcomes, such as surrogates' well-being and decision quality.
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