title: A multi-faceted, family-centred nutrition intervention to optimise nutrition intake of critically ill patients: The OPTICS feasibility study.
abstract: BACKGROUND
  Critically ill patients are at risk of developing malnutrition which contributes to functional decline and hospital re-admission. Strategies to promote nutritional intake have had a modest effect on protein-calorie intake. None have addressed the recovery trajectory of critical illness or incorporated family as advocates.
  
  
  OBJECTIVE
  We evaluated the feasibility and acceptability of a family-centred intervention designed to optimise nutrition during and following recovery from critical illness.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Two Australian adult intensive care units.
  
  
  METHODS
  A convenience sample of 49 patients and their families was recruited. Patients ≥18 years of age anticipated to require mechanical ventilation for at least 2 days were eligible, provided their family visited regularly and were able to communicate in English. Health care professionals including doctors (n=4), nurses (n=20) and dietitians (n=2) also participated.
  
  
  METHODS
  Demographic data were obtained from participants. Recruitment and retention informed study feasibility. Individual and group interviews informed participant views on the acceptability, perception of and experience with the intervention. Inductive analysis was used to analyse qualitative data.
  
  
  RESULTS
  187 (15.8%) patients met the eligibility criteria; 49 patients and 51 family members consented to participate for a 20.3% consent failure rate. We interviewed 33 (67.3%) family members and 13 (43.4%) patients, all of whom considered the intervention acceptable and who would participate in a similar intervention again, given the opportunity. Inductive analysis of qualitative data from all participants identified three themes: variability in in-hospital nutrition support, families as advocates for optimal nutrition, and partnering with health care providers.
  
  
  CONCLUSIONS
  We described a feasible and acceptable family centred intervention that may be effective in promoting nutrition intake in critically ill patients. Further research is required to examine contextual factors impacting implementation of family-centred interventions, particularly those that involve active family participation and advocacy.
authors.affiliation: NHMRC Centre for Research Excellence in Nursing, Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Australia; Gold Coast Health, 1 Hospital Dr., Southport, QLD 4215, Australia. Electronic address: a.marshall@griffith.edu.au.
authors.forename: Andrea P
authors.initials: AP
authors.lastname: Marshall
authors.affiliation: Gold Coast Health, 1 Hospital Dr., Southport, QLD 4215, Australia. Electronic address: Elizabeth.Wake@health.qld.gov.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wake
authors.affiliation: Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia. Electronic address: Leonie.Weisbrodt@health.nsw.gov.au.
authors.forename: Leonie
authors.initials: L
authors.lastname: Weisbrodt
authors.affiliation: Metabolic Syndrome Canada, Canada. Electronic address: rd2good@live.com.
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.affiliation: Gold Coast Health, 1 Hospital Dr., Southport, QLD 4215, Australia. Electronic address: alan.spencer@health.qld.gov.au.
authors.forename: Alan
authors.initials: A
authors.lastname: Spencer
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, 76 Stuart Street, Suite 5-416, Kingston, Ontario, Canada K7L 2V7; Queen's University, 99 University Avenue, Kingston, Ontario, Canada K7L 3N6. Electronic address: dkh2@queensu.ca.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D009748:Nutrition Disorders / Q000517:prevention & control*; D018529:Nutritional Support / Q000592:standards*; D011368:Professional-Family Relations; D011446:Prospective Studies; D011793:Queensland
keywords: Critical illness; Family; Nutrition; Partnership