The Caregiver Pathway Intervention Can Contribute to Reduced Post-Intensive Care Syndrome Among Family Caregivers of ICU Survivors: A Randomized Controlled Trial

Solbjørg Watland; Lise Solberg Nes; Øivind Ekeberg; Morten Rostrup; Elizabeth Hanson; Mirjam Ekstedt; Una Stenberg; Milada Hagen; Elin Børøsund

doi:10.1097/CCM.0000000000006546

The Caregiver Pathway Intervention Can Contribute to Reduced Post-Intensive Care Syndrome Among Family Caregivers of ICU Survivors: A Randomized Controlled Trial

Crit Care Med. 2024 Dec 24. doi: 10.1097/CCM.0000000000006546. Online ahead of print.

Authors

Solbjørg Watland^{1

2

3}, Lise Solberg Nes^{1

3

4}, Øivind Ekeberg⁵, Morten Rostrup^{2

6}, Elizabeth Hanson^{7

8}, Mirjam Ekstedt^{7

9}, Una Stenberg^{10

11}, Milada Hagen¹², Elin Børøsund^{1

13}

Affiliations

¹ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
² Medicine Intensive Care Unit, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway.
³ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN.
⁵ Psychosomatic and CL Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
⁶ Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁷ Linnaeus University, Department of Health and Caring Sciences, Kalmar, Sweden.
⁸ Swedish Family Care Competence Centre, Region Kalmar, Sweden.
⁹ Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
¹¹ Frambu Resource Center for Rare Disorders, Siggerud, Norway.
¹² Faculty of Health Sciences, Oslo Metropolitan University, Oslo Norway.
¹³ Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.

PMID: 39718436
DOI: 10.1097/CCM.0000000000006546

Abstract

Objectives: Explore short-term effects of "The Caregiver Pathway," an intervention for family caregiver follow-up, on Post-Intensive Care Syndrome symptoms among families (PICS-F).

Design: A randomized controlled trial.

Setting: A medical ICU at a Norwegian University Hospital.

Participants: One hundred ninety-six family caregivers of critically ill patients randomized to an intervention (n = 101) or control group (n = 95).

Interventions: "The Caregiver Pathway" four-step model offers individual and structured follow-up, including: 1) mapping family caregivers' needs and concerns with an assessment tool followed by a conversation with an ICU nurse within the first days at the ICU, 2) a supportive card when leaving the ICU, 3) offer for the family caregivers to receive a phone call after ICU patient discharge, and 4) a follow-up conversation within 3 months.

Measurements and main results: Data were collected at baseline and after 3 months and analyzed using linear regression. No significant effects were detected when comparing all participants completing 3-month outcome measurements (n = 144). A subgroups analysis stratified on patient survival, however, showed statistically significant effect for family caregivers of patients surviving the ICU stay receiving the intervention compared with controls. Caregivers of surviving patients reported improved symptoms related to post-traumatic stress disorder, measured by Impact of Event Scale-Revised (B = -8.2 [95% CI, -14.2 to -2.2]; p = 0.008), anxiety (B = -2.2 [95% CI, -4.0 to -0.5]; p = 0.014), and depression (B = -1.5 [95% CI, -2.9 to -0.1]; p = 0.035); measured by the Hospital Anxiety and Depression Scale, subscore physical functioning in health-related quality of life (B = 9.7 [95% CI, 0.3-19.0]; p = 0.043); measured by Short Form 12-Item Health Survey; and hope (B = 2.4 [95% CI, 0.4-4.3]; p = 0.017) and measured by the Herth Hope Index. At 3-month, the model did not appear to improve the outcomes for family caregivers of nonsurviving patients.

Conclusions: "The Caregiver Pathway" intervention was associated with reduced symptoms of PICS-F in family caregivers of surviving ICU patients compared with controls.