Improving Partnerships with Family Members of ICU Patients: The IMPACT Trial

There is a pressing need to improve the care of critically ill older patients. The Canadian population is aging. Technology is advancing. The result is that older, frailer and more complex patients are receiving increasingly invasive therapies late in life. Many patients will benefit from care provided in intensive care units (ICU), surviving illnesses once uniformly fatal. Some will return to their pre-illness functional status. Some will be left with new disabilities. Others will die. There is uncertainty about how to best apply technology to improve healthcare and health for critically ill older patients, to balance length of life with quality of life and to improve compassionate end of life care. The implications are profound for patients, family members, providers and society. New approaches to improving care of the sick, frail, older patient are required.

         Over the last decade, there has been a significant shift in health care systems to focus on patients’ and family members’ experiences, as well as attending to the patient’s disease. For critically ill patients who are unable to participate in their own care and decision-making, partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families. Partnering with family members of critically ill patients has been shown to decrease patient anxiety, confusion and agitation, reduce complications, and decrease length of stay in the ICU. Overall, family partnering is thought to help the patient feel more secure and to increase patient and family member satisfaction with care.

Accordingly, to improve the outcomes of critically ill older patients and the health outcomes of their families, we plan to partner with families to optimize patient/family-centered care. However, the optimal means by which we engage families in the role they play, and how best to capacitate them as advocates and partners in care while helping them maintain their own wellbeing, is not known. The IMPACT trial will evaluate two interventions, each with a separate context, but similar in that they empower and support families. The first is a nutrition intervention and the second is a Decision-support intervention:  

1) The OPTimal nutrition by Informing and Capacitating family members of best practices (OPTICs) intervention, a multi-faceted strategy to engage and empower family members to advocate for and audit best nutrition practices, and

2) The REALISTIC-80 Decision Support Intervention, a web-based tool (www.myicuguide.com) to support families in shared decision-making about goals of medical treatments.

Pilot studies have demonstrated the acceptability and feasibility of both interventions in the ICU.  Both interventions are now ready for further testing.

The IMPACT trial is a mixed methods clinical trial involving 150 families allocated to 3 groups (2 active interventions and a usual care group). The IMPACT trial aims to demonstrate that the tools and training provided to family members will increase their satisfaction with care, and their ability to act as agents of best practice. This will be translated into better patient and family-centred outcomes over the long-term, compared to usual care.

The results of the IMPACT trial will help build the evidentiary basis for a family-partnered care pathway that will improve the functional recovery of critically ill patients and improve the quality of end of life care for both patients and their family members. 

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