The Family Support Intervention in Intensive Care Units (FICUS) trial found that structured support from nurses for families of patients reduced family distress and associated adverse outcomes and boosted ICU satisfaction compared with usual care.
“The effects on communication and support are clinically relevant given the well-documented burden of post-ICU syndrome on family members,” said Timothy Kinsey, DMSc, PA-C, FCCP, Manager of Advanced Practice Providers in Surgery, Endeavor Health.
“These findings point to a tangible strategy to mitigate long-term psychological and emotional harm to families of patients who are critically ill,” Dr. Kinsey said. “From a practice perspective, integrating a clinician with a defined mandate for family engagement, rather than relying on ad hoc communication by the bedside team, could improve family outcomes and address a gap in current ICU care models.”
ICU care traditionally focuses on patients, explained lead author Rahel Naef, PhD, RN, Professor of Implementation Science in Nursing at the University of Zurich Institute for Implementation Science in Health Care and Research Group Head at the University Hospital Zurich Centre for Clinical Nursing Science, Zurich, Switzerland. However, family members can experience profound uncertainty and distress.
Observational studies have found that up to 60% of families of patients in the ICU develop postintensive care syndrome after a critical illness. Poor communication, lack of information, poor access to ICU staff, and emotional distress are all associated with dissatisfaction with ICU care and can result in adverse health outcomes.
“If we look only at the patient, we don’t have ideal conditions for patients to recover or for patients to be comfortable after they leave the ICU,” Dr. Naef said. “Seeing families as part of the care process and partnering with families help us achieve the best possible care for patients.”
Family-focused interventions have long been recommended but are inconsistently implemented in ICUs, Dr. Naef said.
The FICUS study compared usual care and a novel nurse-led role that engaged with families, offered relationship-focused and psychoeducational support, and ensured interprofessional communication throughout the ICU journey. The study added a nurse-led, family-focused care model with regular interactions from ICU admission into post-ICU care.
The program required at least five family interventions, which could be increased based on family needs and patient clinical progress. Interventions were provided by ICU family nurses following a five-day training program in family systems care.
Between December 2022 and February 2024, 16 ICUs across Switzerland participated in the study—eight ICUs with 412 family members in the intervention arm and eight ICUs with 473 family members in usual care arm. The primary outcome was the mean family satisfaction with ICU care based on the 26-item Family Satisfaction with the ICU (FS-ICU) scale. Secondary outcomes included quality of family-clinician communication and family perception of cognitive and emotional support.
The mean FS-ICU score was higher in the intervention arm (81.78) vs usual care arm (79.39), with a mean difference of 2.39 (95% CI, 0.31-4.47; P = .02). Dr. Naef noted that in unplanned admissions—which was the case in 18% of patients—the intervention effect was stronger, resulting in a mean difference of 8.67 in satisfaction between study arms. There was a strong intervention effect on satisfaction with involvement in decision-making with improved quality of family-clinician communication and cognitive/emotional support.
“The findings were very consistent, and we showed this type of program is able to improve care,” Dr. Naef said. “One hospital that participated already implemented this program as routine care. We are looking into ways to scale and spread this intervention outside a clinical trial.”
References
1. Naef R, Jeitziner MM, Riguzzi M, et al. Nurse-led family support intervention for families of critically ill patients: the FICUS cluster randomized clinical trial. JAMA Intern Med. 2025;185(9):1138-1149. doi:10.1001/jamainternmed.2025.3406
