Keywords :
Decision-making, Family, Family satisfaction in the ICU 24 revised, Consideration of need, Intensive care, Treatment of physical symptoms, Perception, Satisfaction, Treatment outcome
Citation Information :
Atri V, Bhatt MT, Chaudhuri S, Mitra A, Maddani SS, Ravindranath S. Family's Perceived Needs and Satisfaction with Intensive Care Services: A Questionnaire-based Prospective Observational Study. Indian J Crit Care Med 2024; 28 (5):483-494.
Background: Holistic intensive care management involves the treatment of critically ill patients in the intensive care unit (ICU) as well as catering to family psychosocial needs helping in bettering satisfaction/perception of care. There is scarce data in the Indian intensive care setting regarding the same, especially in times of increasing end-of-life practices. Our study aimed to determine the factors impacting family perception/satisfaction with intensive care.
Materials and methods: A total of 336 family bystanders of patients in ICU with more than 72 hours of stay were surveyed using family satisfaction in the ICU 24 revised (FS-ICU 24R) questionnaire.
Results: Multivariable logistic regression analysis showed that the significant factors associated with the satisfaction among bystanders of ICU patients were the treatment of patient's physical symptoms like pain/breathlessness (Adjusted OR 3.73, p = 0.003), ICU staff's approach to family's need consideration (Adjusted OR 4.44, p < 0.001), concern and care towards patients’ family (Adjusted OR 2.67, p = 0.023). Participation in patient care, ICU waiting room atmosphere, and emotional support are the other factors independently associated with satisfaction with ICU care. Family satisfaction was not associated with the patient's survival (p = 0.331, Chi-square test) or the length of ICU (p = 0.328, Chi-square test) and hospital stay (p = 0.865, Chi-square test).
Conclusion: Treatment of a patient's physical symptoms like pain, approach to family's needs consideration, and concern/care towards the patient's family are independent factors associated with optimal satisfaction among family members of ICU patients, which even takes precedence over the survival outcomes or length of ICU stay.
Ministry of Health and Family Welfare. Life expectancy in India. Available from https://pib.gov.in/PressReleasePage.aspx?PRID=1606209.
Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med 2008;36(6):1722–1728. DOI: 10.1097/CCM.0b013e318174da72.
Pochard F, Darmon M, Fassier T, Bollaert PE, Cheval C, Coloigner M, et al. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicentric study. J Crit Care 2005;20(1):90–96. DOI: 10.1016/j.jcrc.2004.11.004.
Anderson WG, Arnold RM, Angus DC, Bryce CL. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 2008;23(11):1871–1876. DOI: 10.1007/s11606-008-0770-2.
Salins N. Measuring family satisfaction in an Indian Intensive Care Unit. Indian J Crit Care Med 2015;19(9):505–506. DOI: 10.4103/0972-5229.164794.
Molter NC. Needs of relatives of critically ill patients: A descriptive study. Heart Lung 1979;8(2):332–339. PMID: 253712.
de Vos M, Graafmans W, Keesman E, Westert G, van der Voort PH. Quality measurement at intensive care units: Which indicators should we use? J Crit Care 2007;22(4):267–274. DOI: 10.1016/j.jcrc.2007.01.002.
Ministry of Finance. Share of government health expenditure in total health expenditure. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1894902.
Venkataraman R, Ranganathan L, Rajnibala V, Abraham BK, Rajagopalan S, Ramakrishnan N. Critical care – Are we customer friendly? Indian J Crit Care Med 2015;19(9):507–512. DOI: 10.4103/0972-5229.164796.
Pillai LV, Ambike D, Husainy S, Vaidya N, Kulkarni SD, Aigolikar S. The prevalence of post-traumatic stress disorder symptoms in relatives of severe trauma patients admitted to the intensive care unit. Indian J Crit Care Med 2006;10(3):181–186. DOI: 10.4103/0972-5229.27860.
Kulkarni HS, Kulkarni KR, Mallampalli A, Parkar SR, Karnad DR, Guntupalli KK. Comparison of anxiety, depression, and post-traumatic stress symptoms in relatives of ICU patients in an American and an Indian public hospital. Indian J Crit Care Med 2011;15(3):147–156. DOI: 10.4103/0972-5229.84891.
FS-ICU 24R. Family satisfaction with the ICU survey. Available from: https://fsicu.org/professionals/survey/.
Fathallah I, Drira H, Habacha S, Kouraichi N. Can We satisfy family in intensive care unit? A Tunisian experience. Indian J Crit Care Med 2022;26(2):185–191. DOI: 10.5005/jp-journals-10071-24104.
Jayaram R, Ramakrishnan N. Cost of intensive care in India. Indian J Crit Care Med 2008;12(2):55–61. DOI: 10.4103/0972-5229.42558.
Parikh CR, Karnad DR. Quality, cost, and outcomes of intensive care in a public hospital in Bombay, India. Crit Care Med 1999;27(9): 1754–1759. DOI: 10.1097/00003246-199909000-00009.
Liang Y, Li J, Pan W. Family satisfaction in the intensive care unit: The influence of disease severity, care relationship, patient anxiety and patient pain. Intensive Crit Care Nurs 2021;63:102995. DOI: 10.1016/j.iccn.2020.102995.
Borghans I, Kleefstra SM, Kool RB, Westert GP. Is the length of stay in hospital correlated with patient satisfaction? Int J Qual Health Care 2012;24(5):443–451. DOI: 10.1093/intqhc/mzs037.
Mani RK, Simha SN, Gursahani R. The advance directives and foregoing of life support: Where do we stand now? Indian J Crit Care Med 2018;22(3):135–137. DOI: 10.4103/ijccm.IJCCM_116_18.
Salins N, Gursahani R, Mathur R, Iyer S, Macaden S, Simha N, et al. Definition of terms used in limitation of treatment and providing palliative care at the end of life: The Indian Council of Medical Research Commission Report. Indian J Crit Care Med 2018;22(4): 249–262. DOI: 10.4103/ijccm.IJCCM_165_18.
Simha SN. The advance directives and foregoing of life support: Where do we stand now? Indian J Crit Care Med 2018;22(3):135–137. DOI: 10.4103/ijccm.IJCCM_116_18.
Reportable in the Supreme Court of India Civil Original Jurisdiction. Common Cause vs. the Union of India. Writ Petition (Civil) No. 215 of 2005. Available from: http://www.supremecourtofindia.nic.in/supremecourt/2005/9123/9123_2005_Judgement_09-Mar-2018.pdf.
Myatra SN, Salins N, Iyer S, Macaden SC, Divatia JV, Muckaden M, et al. End-of-life care policy: An integrated care plan for the dying: A Joint Position Statement of the Indian Society of Critical Care Medicine (ISCCM) and the Indian Association of Palliative Care (IAPC). Indian J Crit Care Med 2014;18(9):615–635. DOI: 10.4103/0972-5229.140155.
Kennedy G. The importance of patient dignity in care at the end of life. Ulster Med J 2016;85(1):45–48. PMID: 27158166.
Gerry E. Privacy and dignity in a hospice environment – The development of a clinical audit. BMJ Supportive & Palliative Care 2011;1:244. DOI: http://dx.doi.org/10.1136/bmjspcare-2011-000105.121.
Rego F, Gonçalves F, Moutinho S, Castro L, Nunes R. The influence of spirituality on decision-making in palliative care outpatients: A cross-sectional study. BMC Palliat Care 2020;19(1):22. DOI: 10.1186/s12904-020-0525-3.