A family information brochure and dedicated website to improve the ICU experience for patients' relatives: an Italian multicenter before-and-after study.
OBJECTIVE
Good communication between ICU staff and patients' relatives may reduce the occurrence of post-traumatic stress disorder, anxiety or depression, and dissatisfaction with clinicians. An information brochure and website to meet relatives' needs were designed to explain in technical yet simple terms what happens during and after an ICU stay, to legitimize emotions such as fear, apprehension, and suffering, and to improve cooperation with relatives without increasing staff workload. The main outcomes were improved understanding of prognosis and procedures, and decrease of relatives' anxiety, depression, and stress symptoms.


METHODS
In this prospective multicenter before-and-after study, a self-administered questionnaire was used to investigate relatives' understanding of prognosis, treatments, and organ dysfunction, families' satisfaction, and symptoms of anxiety, depression, and post-traumatic stress.


RESULTS
A total of 551 relatives received questionnaires in nine Italian ICUs; 332 (60%) responded, 144 before and 179 after implementation of the brochure and website. Of the 179 relatives who responded after, 131 (73%) stated they had read the brochure and 34 (19%) reported viewing the website. The intervention was associated with increased correct understanding of the prognosis (from 69 to 84%, p = 0.04) and the therapeutic procedures (from 17 to 28%, p = 0.03). Multivariable analysis, together with non-modifiable factors (relative's gender, education level, relationship to patient, and patient status at ICU discharge), showed the intervention to be significantly associated with a lower incidence of post-traumatic stress symptoms (Poisson coefficient = -0.29, 95% CI -0.52/-0.07). The intervention had no effect on the prevalence of symptoms of anxiety and depression.


CONCLUSIONS
An information brochure and website designed to meet relatives' needs improved family members' comprehension and reduced their prevalence of stress symptoms.
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo-Polo Universitario, Via A. Di Rudinì 8, 20142, Milan, Italy. giovanni.mistraletti@unimi.it.|U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy. giovanni.mistraletti@unimi.it.
Giovanni
http://orcid.org/0000-0001-8322-1623
G
Mistraletti
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Michele
M
Umbrello
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Elena Silvia
ES
Mantovani
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo-Polo Universitario, Via A. Di Rudinì 8, 20142, Milan, Italy.
Benedetta
B
Moroni
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Paolo
P
Formenti
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Paolo
P
Spanu
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Stefania
S
Anania
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Elisa
E
Andrighi
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Alessandra
A
Di Carlo
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Federica
F
Martinetti
U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Irene
I
Vecchi
U.O. Anestesia e Rianimazione 1, I.R.C.C.S. San Matteo, Pavia, Italy.
Alessandra
A
Palo
U.O. Anestesia e Rianimazione, Dipartimento di Area Critica, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy.
Cristina
C
Pinna
U.O.C. Rianimazione e Terapia Intensiva, Fondazione I.R.C.C.S. Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Riccarda
R
Russo
U.O.C. Anestesia e Rianimazione, A. O. Ospedale Civile di Desio, Desio, Milan, Italy.
Silvia
S
Francesconi
U.O. Anestesia e Rianimazione, A.O. Ospedale Civile di Legnano, Legnano, Milan, Italy.
Federico
F
Valdambrini
S.C. Anestesia Rianimazione B DEA, Ospedale San Giovanni Bosco, Turin, Italy.
Enrica
E
Ferretti
U.O. Anestesia e Rianimazione, A.O. U. San Luigi Gonzaga di Orbassano, Orbassano, Turin, Italy.
Giulio
G
Radeschi
U.O. Anestesia e Rianimazione, A.O. Cardinal Massaia, Asti, Italy.
Edda
E
Bosco
U.O. Anestesia e Rianimazione-P.S, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Paolo
P
Malacarne
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, A.O. San Paolo-Polo Universitario, Via A. Di Rudinì 8, 20142, Milan, Italy.|U.O. Anestesia e Rianimazione, Dipartimento Emergenza-Urgenza, A.O. San Paolo-Polo Universitario, Milan, Italy.
Gaetano
G
Iapichino
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000517:prevention & control; D003142:Communication; D003194:Computer-Assisted Instruction; D003422:Critical Care / Q000458:organization & administration*; D003863:Depression / Q000517:prevention & control; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D011368:Professional-Family Relations; D011446:Prospective Studies; D011795:Surveys and Questionnaires
Communication strategies; Critically ill patients; ICU families; Post-traumatic stress disorder; Website