Important and feasible patient- and family-centered intensive care interventions: A Delphi study with stakeholders

Intensive care unit (ICU) admissions can be stressful for patients and family members. Patients may face discomfort, pain, delirium, immobility, and uncertainty about recovery, while family members often experience emotional strain, uncertainty and fatigue. Patient- and family-centered care (PFCC) is a guideline recommended approach to reduce ICU-burden for both patient and family members. However, which interventions are important and feasible for PFCC in the ICU is unknown.

To explore which PFCC interventions are most important and feasible in the ICU according to Dutch clinicians, patients and family members.

A 4-stage modified RAND/UCLA Appropriateness Method (RAM) Delphi study was conducted. First, a literature review and focus group interviews were used to identify important and feasible PFCC interventions. Second, ICU-stakeholders (nurses, physicians, patients and family members), rated interventions on importance and feasibility and added comments. Third, stakeholders discussed interventions rated as uncertain on importance and feasibility and created a second set of interventions. Fourth, stakeholders rated interventions from stage 3 on importance and feasibility and ranked interventions resulting in a top 5 of most important interventions.

In total, 30 former patients and family members and 46 healthcare professionals participated. 35 interventions for PFCC in the ICU were identified. Of these, 31 were rated as both important and feasible, and four were rated as uncertain. The five highest-rated interventions focused on regular multidisciplinary conversations with patients and families about care and treatment plans, keeping a patient diary, offering psychological support from consultants, creating a tailored daily schedule, and ensuring consistent communication with the patient's contact person.

Implementing interventions rated highly on both importance and feasibility may significantly enhance ICU care experiences for patients and families. The top five rated interventions indicate what was considered most important in minimizing the impact of an ICU admission.