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KEY POINTS

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  • Family members of ICU patients often serve as surrogate decision makers and are at high risk to develop long-term psychological problems, such as depression, anxiety, and posttraumatic stress disorder.

  • Proactive communication has been shown to be an important factor improving satisfaction and lower psychological burden in families of patients dying in the ICU (end-of-life situation).

  • It can be assumed that around 50% of family members do not understand the diagnosis, prognosis, and treatment of their loved ones. Better information and higher completeness of information have been shown to result in increased family satisfaction.

  • Relatives' preference for involvement in the decision-making process varies. Physicians should respect their preference and adapt the family conference accordingly.

  • Family conferences can be improved if (a) they occur promptly after ICU admission of the patient, (b) information is consistent across treating teams, (c) there is an adequate room for the conference with privacy and good atmosphere, and (d) health care workers ensure that in an end-of-life situation the patient will not suffer and provide explicit support for decisions made by the family.

  • Empathic statements and more time listening to family members (and less time talking by health care workers) improve families' experiences in the ICU.

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INTRODUCTION

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In recent years, the focus of health care workers in the critical care settings has broadened from looking at disease only to patient- and family-centered care. In line with this, the Institute of Medicine defines high-quality care as safe, timely, efficient, effective, equitable, and patient centered,1 which includes family-centered care. Put another way, patient- and family-centered care is an intrinsic part of the delivery of high-quality health care.

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Family-centered care is particularly important in an intensive care setting because patients are frequently unable to participate in their care due to sedation, delirium, and their degree of illness. Thus, family members frequently serve as surrogate decision makers, a role that brings enormous pressure and may result in significant psychological burden and long-term morbidity. Clinical research has demonstrated that proactive communication and high level of care for relatives can lower their psychological burden and prevent posttraumatic stress disorder (PTSD), anxiety, and depression in this population. In this chapter, we will discuss principles of caring for families of ICU patients, an area of evolving importance.

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THE PROBLEM: PSYCHOLOGICAL BURDEN OF CRITICAL CARE ON PATIENTS' RELATIVES

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Families of ICU patients are at a surprisingly high risk of developing long-term psychological problems, as well as somatic illnesses, as a direct result of their family members' ICU stay and illness. It has been demonstrated that up to 80% of families of critical care patients suffer from deleterious effects from their ICU experience.2 Family members are at increased risk for anxiety and depression, which may manifest during the initial ICU stay of the patient, but may also persist for a long time or appear only after discharge or death ...

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