Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005.
OBJECTIVE
To develop clinical practice guidelines for the support of the patient and family in the adult, pediatric, or neonatal patient-centered ICU.


METHODS
A multidisciplinary task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) to include representation from adult, pediatric, and neonatal intensive care units.


METHODS
The task force members reviewed the published literature. The Cochrane library, Cinahl, and MedLine were queried for articles published between 1980 and 2003. Studies were scored according to Cochrane methodology. Where evidence did not exist or was of a low level, consensus was derived from expert opinion.


METHODS
The topic was divided into subheadings: decision making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, family visitation, family presence on rounds, family presence at resuscitation, family environment of care, and palliative care. Each section was led by one task force member. Each section draft was reviewed by the group and debated until consensus was achieved. The draft document was reviewed by a committee of the Board of Regents of the ACCM. After steering committee approval, the draft was approved by the SCCM Council and was again subjected to peer review by this journal.


CONCLUSIONS
More than 300 related studies were reviewed. However, the level of evidence in most cases is at Cochrane level 4 or 5, indicating the need for further research. Forty-three recommendations are presented that include, but are not limited to, endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and family-friendly signage, and family support before, during, and after a death.
Davidson
Judy E
JE
Powers
Karen
K
Hedayat
Kamyar M
KM
Tieszen
Mark
M
Kon
Alexander A
AA
Shepard
Eric
E
Spuhler
Vicki
V
Todres
I David
ID
Levy
Mitchell
M
Barr
Juliana
J
Ghandi
Raj
R
Hirsch
Gregory
G
Armstrong
Deborah
D
D003422:Critical Care / Q000592:standards*; D005192:Family Health; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D010166:Palliative Care / Q000592:standards; D018802:Patient-Centered Care / Q000592:standards*; D011368:Professional-Family Relations; D012944:Social Support; D029181:Spirituality; D014789:Visitors to Patients