Journal Club Express: ICU Nurse-Led Communication, shorter stay and better ratings?

A Randomized Trial of a Family-Support Intervention in Intensive Care Units Douglas B. White et al. for the PARTNER Investigators Surrogate decision makers (e.g. family and friends) for incapacitated, critically ill patients can understandably find it very difficult to make decisions related to goals of care. Having to make such decisions can cause them psychological distress and may lead to treatment that is not exactly what the patient might have chosen if they could speak for themselves. In this trial the investigators conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates (folks speaking for them) in five intensive care units (ICUs). They compared what they term “a multicomponent family-support intervention delivered by the interprofessional ICU team” with usual care. A total of 1420 patients were enrolled in the trial. Results The family-support intervention delivered by the interprofessional ICU team did not significantly reduce the burden of psychological symptoms for the surrogates. However their ratings of the quality of communication and the patient- and family - centered care were better. Furthermore - the length of stay in the intensive care unit was shorter. Compelling, in favour of this team approach, but the authors suggest we shouldn’t 'dive straight in'; rather that a large replication trial may be conducted, in multiple geographic regions, to establish the findings further. Thus recognising different health systems have potentially different attitudes and practices regarding care for patients with advanced critical illness. We will be delving into this excellent paper at greater length in an upcoming journal club. Link to paper: The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa1802637 Link to the accompanying editorial by Daniela Lamas, Nurse-Led Communication in the Intensive Care Unit: https://www.nejm.org/doi/full/10.1056/NEJMe1804576