December 2, 2018

Intensive Care Medicine journal


Questions to improve family-staff communication in the ICU: a randomized controlled trial. Intensive Care Med (2018) 44:1879-1887. Azoulay E. et al for the FAMIREA group

Patients’ families play a major and growing part in the care of critically ill patients, particularly during decision-making, and adequate communication is the keystone to fulfil this role without increasing their emotional distress. Clinical trials of interventions to improve comprehension about diagnosis, prognosis and goals of care have shown mixed results, as found in the recent studies on palliative care-led meetings for families [1], or in a multicomponent family-support intervention delivered by the ICU team [2]. Although the latter did not succeed in reducing the burden of anxiety, relatives did find an improvement in communication and patient and family-centred care.

In 2011, the FAMIREA group developed a list of 21 questions, rated by family and staff members, identifying the informational needs for which they would seek answers. Based on this project, Azoulay et al. developed a new prospective, randomized, parallel-group trial [3] evaluating whether providing patient’s relatives with this list would encourage them to ask relevant questions and help them to have a better understanding. Comprehension, family satisfaction, and the prevalence of anxiety and depression, were assessed at a family meeting on day 5, and staff members encouraged to answer all the questions in the meantime and during a formal family meeting held on day 3.

14 ICUs from the FAMIREA group in France participated in this trial from April 1, 2014 to April 1, 2016. They randomized 394 relatives, 302 of whom underwent the day-5 assessment, 148 of whom were included in the intervention group and 154 in the control group. Results showed no difference between the intervention and the control group, neither with regard to comprehension nor their satisfaction or symptoms of depression and anxiety.

As shown in this study, proposing a single intervention based on a validated list of questions did not improve the quality of family-staff communication in the emotionally charged context of critical care, where this issue remains one of the most challenging aspects of patient and family-centred care. Nevertheless, in the intervention group there was a trend of higher comprehension in longer meetings on day 3, even though it did not achieve statistical significance. The use of this list as a facilitator could be a first element in a multimodal strategy to improve communication, and further research in this perspective should be conducted..

Article review prepared and submitted by Silvia Calviño Günther, member of the N&AHP Committee, ESICM.


1) Carson S.S., Cox C.E., Wallenstein S., Hanson L.C., Danis M,, Tulsky J.A., Chai E. and Nelson J.E. Effect of Palliative Care-Led Meetings for Families of Patients with Chronic Critical Illness: A Randomized Clinical Trial. JAMA (2016) 316 (1): 21-62. DOI: 10.1001/jama.2016.8474.

2) White D.B., et al for the PARTNER group. A Randomized Trial of a Family-Support Intervention in Intensive Care Units. N Engl J Med (2018) 378; 25: 2365-2375. DOI: 10.1025/NEJMoa1802637.

3) Azoulay E. et al for the FAMIREA group. Questions to improve family-staff communication in the ICU: a randomized controlled trial. Intensive Care Med (2018) 44:1879-1887.


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