title: Impact of chronic critical illness on the psychological outcomes of family members.
abstract: The uncertain trajectory of chronic critical illness exposes the patient's family to heightened levels of psychological distress. Symptoms of psychological distress affect more than half of family members exposed to the patient's chronic critical illness. Although symptoms often dissipate over time, a significant proportion of family members will remain at moderate to high risk for psychological distress well after the patient's death or discharge from the intensive care unit. Family members of chronically critically ill patients are often involved in the decision making for the patients. Irrational or uninformed decision making can occur when family members experience high levels of psychological distress. Attention to the psychological needs and provision of support to family members enhance the formulation of treatment decisions consistent with the patient's preferences and mitigate unnecessary resource use. In this article, the impact of chronic critical illness on family members' risk for depression, anxiety, and posttraumatic stress disorder is described and a review of evidence-based strategies to support the psychological needs of family members coping with a patient's chronic critical illness is provided.
authors.affiliation: Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA. ronald.hickman@case.edu
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hickman
authors.forename: Sara L
authors.initials: SL
authors.lastname: Douglas
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety; D002908:Chronic Disease; D003142:Communication; D003422:Critical Care; D016638:Critical Illness / Q000451:nursing*; D003657:Decision Making; D003863:Depression; D019317:Evidence-Based Medicine; D055318:Evidence-Based Nursing; D022143:Family Nursing / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D013313:Stress Disorders, Post-Traumatic; D013315:Stress, Psychological