Family Support Intervention in Intensive Care Units

NCT ID: NCT05280691

Last Updated: 2025-07-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 885 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-05-12
• Study Completion Date: 2024-12-31

Brief Summary

Background: Family members of critically ill patients face considerable uncertainty and distress during their close other's intensive care unit (ICU) stay, with about 20-60% of family members experiencing post-traumatic distress post-ICU. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation.

Methods: To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, the investigators will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. The trial will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 hours or longer. Families in the control arm will receive usual care. Families in the intervention arm, in addition to usual care, will receive a family support intervention consisting of specialist nurse support along the patient pathway at defined time-points, including follow-up care, and nurse-coordinated liaison and structured, interprofessional communication by the ICU team. The primary study endpoint is quality of family care, operationalized as family members' satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members' mental health (well-being, psychological distress) measured at admission, discharge, and after three, six, and twelve months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference.

Discussion: The FICUS trial will establish the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and whether an effective intervention could be scaled-up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being.

Detailed Description

Background: Family members are important to the well-being and recovery of critically ill persons, yet are themselves profoundly affected by the critical illness. During a close other's treatment in an intensive care unit (ICU), families experience high levels of stress and uncertainty, particularly in the event of surrogate decision-making and loss. Poor communication, insufficient shared decision-making, and inadequate emotional and practical support by intensive care staff have been found to add to families' burden. Poor-quality care has been associated with adverse mental health outcomes, which is reported by 20-60% of family members. A lack of engagement and support, coupled with acute stress, not only increases family suffering, but affects family members' functioning in everyday life, and limits their ability to engage in caregiving activities needed by the survivor of critical illness or cope with their loss.

Rationale: To increase the quality of family care and prevent adverse mental health outcomes, ICU guidelines recommend family engagement, communication, and support as well as the use of specific roles, but the evidence base for these recommendations is weak to date. Only a few studies have investigated family support interventions that consist of structured communication and / or specific family nursing roles. Promising effects have been found on family members' communication and support experience. However, findings on psychological distress remain inconclusive whereas insights on family management ability are virtually absent. Moreover, best practice around family engagement in ICU is often not implemented consistently in routine care. Hence, real-world evidence generated by randomized controlled designs is necessary to establish the effect of such multi-component interventions on quality of family care and their potential in supporting family management of critical illness and in reducing adverse mental health outcomes.

Aims: The study aims to determine the effect of a guideline-based, nurse-led, interprofessional family support intervention on quality of family care, family management, and individual mental health compared to usual care provided to family members. The study also aims to identify implementation barriers/enablers in the real-world context in which the study intervention is implemented to discern determinants and strategies of implementation success.

Methodology: The trial is designed as a multi-center, parallel cluster randomized superiority hybrid-type 1 trial with 8 clusters per study arm and a projected sample size of 896 family members of adult, critically ill patients treated in acute care hospitals in the German-speaking part of Switzerland. It will target family members with great needs, such as those of patients with more complex and longer-lasting critical illness, those of patients admitted with a life-threatening condition, and those who are required to make surrogate decisions. Family members of patients requiring short-lasting peri-operative or peri-interventional ICU treatment will be excluded. In addition to usual care, families in the intervention group will receive (1) specialist nurse support along the patient pathway at defined time-points, from admission to discharge with subsequent follow-up care, and (2) nurse-coordinated liaison and structured, interprofessional communication by the ICU team. Family members in the control group will receive usual care. The primary study endpoint is quality of family care, operationalized as family members' satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and index family members' mental health (well-being, psychological distress) obtained upon admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference. A mixed-method study will be used to examine implementation barriers / facilitators and successful strategies at intervention units.

Expected outcomes and impact: The FICUS trial will establish the effectiveness of the family support intervention and generate knowledge on effective implementation processes. Both types of evidence are necessary to determine whether the intervention works as intended, but also to explore how it works in clinical practice, so that an effective intervention could be scaled-up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being. They will also promote evidence-based family care in ICU.

Conditions

Postintensive Care Syndrome; Family Members; Quality of Life; Depression, Anxiety; Posttraumatic Stress Disorder; Family Dynamics

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: NONE

Study Groups

Family Support Intervention

Families in the intervention group receive the Family Support Intervention in addition to usual care

Group Type: OTHER

Family Support Intervention (FSI)

Intervention Type: OTHER

In addition to usual care, families in the intervention group will receive (1) specialist nurse support along the patient pathway at defined time-points, from admission to discharge including follow-up care, and (2) nurse-coordinated liaison and structured, interprofessional communication by the ICU team. The intervention is grounded in a family systems approach and guideline-based strategies for family engagement in the ICU and has been pilot-tested in one ICU.

Usual Care

Families in the control group will receive usual care.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Family Support Intervention (FSI)

In addition to usual care, families in the intervention group will receive (1) specialist nurse support along the patient pathway at defined time-points, from admission to discharge including follow-up care, and (2) nurse-coordinated liaison and structured, interprofessional communication by the ICU team. The intervention is grounded in a family systems approach and guideline-based strategies for family engagement in the ICU and has been pilot-tested in one ICU.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Expected length of stay in ICU ≥48 hours, as predicted by the intaking ICU clinician (physician or nurse) at admission.
• Life-threatening condition with a high risk of death or long-lasting functional impairment.
• High risk of prolonged mechanical ventilation (>24 hours).

• Primary support person of the patient.
• Able to complete family-reported outcome measures (questionnaires) in German language.
• Age ≥18 years.
• Signed informed consent form.

Exclusion Criteria

• Preexisting declined general consent.
• ICU stay <24 hours.

• Prior inclusion in FICUS trial on another study ICU.
• Cognitive inability to understand the study or complete the questionnaire as appraised by clinicians and / or study recruitment staff.
• Inability to complete baseline data collection within the required timeframe after admission / study enrollment (Calvert et al., 2018).

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Swiss National Science Foundation

OTHER

Sponsor Role: collaborator

Rahel Naef

OTHER

Sponsor Role: lead

Responsible Party

Rahel Naef

Assistant Professor of Implementation Science in Nursing

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Rahel Naef, PhD, RN

Role: PRINCIPAL_INVESTIGATOR

University of Zurich

Miodrag Filipovic, MD

Role: PRINCIPAL_INVESTIGATOR

Cantonal Hospital St. Gallen

Marie-Madlen Jeitziner, PhD, RN

Role: PRINCIPAL_INVESTIGATOR

University Hospital Bern, Inselspital

Locations

Cantonal Hospital Winterthur

Winterthur, Canton of Zurich, Switzerland

Cantonal Hospital Baden

Baden, , Switzerland

Lindenhof-Hospital

Bern, , Switzerland

University Hospital Bern - Inselspital

Bern, , Switzerland

Cantonal Hospital Graubünden

Chur, , Switzerland

Spital Thurgau AG, Cantonal Hospital Frauenfeld

Frauenfeld, , Switzerland

Lucerne Cantonal Hospital

Lucerne, , Switzerland

Solothurn Hospitals AG, Cantonal Hospital Olten

Olten, , Switzerland

Cantonal Hospital St. Gallen

Sankt Gallen, , Switzerland

Hospital Thun

Thun, , Switzerland

University Hospital Zurich

Zurich, , Switzerland

Hirslanden Clinic Zurich

Zurich, , Switzerland

Countries

Switzerland

References

Oesch S, Verweij L, Riguzzi M, Finch T, Naef R. Exploring Implementation Processes of a Multicomponent Family Support Intervention in Intensive Care Units (FICUS) Study: A Mixed-Methods Process Evaluation. J Adv Nurs. 2024 Oct 18. doi: 10.1111/jan.16544. Online ahead of print.

Reference Type: BACKGROUND

PMID: 39422155 (View on PubMed)

Verweij L, Oesch S, Naef R. Tailored implementation of the FICUS multicomponent family support intervention in adult intensive care units: findings from a mixed methods contextual analysis. BMC Health Serv Res. 2023 Dec 1;23(1):1339. doi: 10.1186/s12913-023-10285-1.

Reference Type: BACKGROUND

PMID: 38041092 (View on PubMed)

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Reference Type: BACKGROUND

PMID: 11350995 (View on PubMed)

Naef R, Filipovic M, Jeitziner MM, von Felten S, Safford J, Riguzzi M, Rufer M. A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial). Trials. 2022 Jun 27;23(1):533. doi: 10.1186/s13063-022-06454-y.

Reference Type: BACKGROUND

PMID: 35761343 (View on PubMed)

Oesch S, Verweij L, Clack L, Finch T, Riguzzi M, Naef R. Implementation of a multicomponent family support intervention in adult intensive care units: study protocol for an embedded mixed-methods multiple case study (FICUS implementation study). BMJ Open. 2023 Aug 8;13(8):e074142. doi: 10.1136/bmjopen-2023-074142.

Reference Type: BACKGROUND

PMID: 37553195 (View on PubMed)

Naef R, Jeitziner MM, Riguzzi M, von Felten S, Verweij L, Rufer M, Safford J, Sutter S, Bergmann-Kipfer B, Betschart U, Boltshauser S, Brulisauer N, Brunner C, Buhler PK, Burkhalter H, Dullenkopf A, Heise A, Hertler B, Hoffmann JE, Karde C, Keller Y, Kohler S, Lussmann F, Massarotto P, Moser M, Pietsch U, Segalada DL, Siegrist E, Steiger P, Ruch N, von Dach C, Wenzler MS, Wiegand J, Zante B, Filipovic M; FICUS Study Group. Nurse-Led Family Support Intervention for Families of Critically Ill Patients: The FICUS Cluster Randomized Clinical Trial. JAMA Intern Med. 2025 Sep 1;185(9):1138-1149. doi: 10.1001/jamainternmed.2025.3406.

Reference Type: DERIVED

PMID: 40720110 (View on PubMed)

von Felten S, Filipovic M, Jeitziner MM, Verweij L, Riguzzi M, Naef R. Multicomponent family support intervention in intensive care units: statistical analysis plan for the cluster-randomized controlled FICUS trial. Trials. 2024 Aug 28;25(1):568. doi: 10.1186/s13063-024-08351-y.

Reference Type: DERIVED

PMID: 39198900 (View on PubMed)

Related Links

https://data.snf.ch/grants/grant/198778

Project database of the Swiss National Science Fund (SNSF)

Other Identifiers

0001

Identifier Type: -

Identifier Source: org_study_id