Recognizing, naming, and measuring a family intensive care unit syndrome

Giora Netzer, Donald Sullivan

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Most major decisions in the intensive care unit (ICU) regarding goals of care are shared by clinicians and someone other than the patient. Multicenter clinical trials focusing on improved communication between clinicians and these surrogate decision makers have not reported consistently improved outcomes. We suggest that acquired maladaptive reasoning may contribute importantly to failure of the intervention strategies tested to date. Surrogate decision makers often suffer signi ficant psychological morbidity in the form of stress, anxiety, depression, and post-traumatic stress disorder. Family members in the ICU also suffer cognitive blunting and sleep deprivation. Their decision-making abilities are eroded by anticipatory grief and cognitive biases, while personal and family con flicts further impact their decision making. We propose recognizing a family ICU syndrome to describe the morbidity and associated decision-making impairment experienced bymany familymembers of patients with acute critical illness (in the ICU) and chronic critical illness (in the long-term, acute care hospital). Research rigorously using models of compromised decision making may help elucidate both mechanisms of impairment and targets for intervention. Better quantifying compromised decision making and its relationship to poor outcomes will allow us to formulate and advance useful techniques. The use of decision aids and improving ICU design may provide benefit now and in the near future. In measuring interventions targeting cognitive barriers, clinically significant outcomes, such as time to decision, should be considered. Statistical approaches, such as survival models and rank statistic testing, will increase our power to detect differences in our interventions.

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalAnnals of the American Thoracic Society
Volume11
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Intensive Care Units
Decision Making
Critical Illness
Patient Care Planning
Morbidity
Aptitude
Sleep Deprivation
Grief
Decision Support Techniques
Long-Term Care
Post-Traumatic Stress Disorders
Multicenter Studies
Chronic Disease
Anxiety
Communication
Clinical Trials
Depression
Psychology
Survival
Research

Keywords

  • Caregivers
  • Communication
  • End of life care
  • Intensive care units
  • Life support care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Recognizing, naming, and measuring a family intensive care unit syndrome. / Netzer, Giora; Sullivan, Donald.

In: Annals of the American Thoracic Society, Vol. 11, No. 3, 2014, p. 435-441.

Research output: Contribution to journalArticle

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