Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members-A Multicenter, Multinational, Before-and-After Intervention Trial

Crit Care Med. 2020 Feb;48(2):176-184. doi: 10.1097/CCM.0000000000004113.


Objectives: To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members.

Design: Prospective, before-and-after intervention evaluation.

Setting: Two U.S. academic medical ICU's, and one Italian academic medical/surgical ICU.

Subjects: Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission.

Interventions: A novel intervention titled "Family Care Rituals" during which, following a baseline observation period, family members enrolled in the intervention phase were given an informational booklet outlining opportunities for engagement in care of the patient during their ICU stay.

Measurements and main results: Primary outcome was symptoms of post-traumatic stress disorder in family members 90 days after patient death or ICU discharge. Secondary outcomes included symptoms of depression, anxiety, and family satisfaction. At 90-day follow-up, 131 of 226 family members (58.0%) responded preintervention and 129 of 226 family members (57.1%) responded postintervention. Symptoms of post-traumatic stress disorder were significantly higher preintervention than postintervention (39.2% vs 27.1%; unadjusted odds ratio, 0.58; p = 0.046). There was no significant difference in symptoms of depression (26.5% vs 25.2%; unadjusted odds ratio, 0.93; p = 0.818), anxiety (41.0% vs 45.5%; unadjusted odds ratio, 1.20; p = 0.234), or mean satisfaction scores (85.1 vs 89.0; unadjusted odds ratio, 3.85; p = 0.052) preintervention versus postintervention 90 days after patient death or ICU discharge.

Conclusions: Offering opportunities such as family care rituals for family members to be involved with providing care for family members in the ICU was associated with reduced symptoms of post-traumatic stress disorder. This intervention may lessen the burden of stress-related symptoms in family members of ICU patients.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anxiety / epidemiology
  • Anxiety / prevention & control
  • Ceremonial Behavior*
  • Consumer Behavior
  • Depression / epidemiology
  • Depression / prevention & control
  • Family / psychology*
  • Female
  • Humans
  • Intensive Care Units / organization & administration*
  • Male
  • Middle Aged
  • Patient Discharge
  • Prospective Studies
  • Sex Factors
  • Socioeconomic Factors
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / prevention & control*
  • Stress, Psychological / epidemiology
  • Stress, Psychological / prevention & control
  • Young Adult