FICUS: Nurse-Led Family Support Intervention

• In ICU
• Wed, 6 Aug 2025

Family members of ICU patients often experience intense distress, uncertainty, and a high risk of postintensive care syndrome–family, with 20–30% reporting significant caregiver burden. They frequently lack adequate communication and support from ICU staff, contributing to negative experiences and poor health outcomes. While family-focused interventions, such as structured communication and support, are recommended to address these issues, they are inconsistently implemented, and evidence of their effectiveness is mixed. 

The Family Support in Intensive Care Units (FICUS) trial tested a nurse-led, interprofessional family support intervention designed to improve family-centred care, reduce caregiver burden, and enhance family mental health. The intervention aimed to improve family satisfaction, communication, and emotional support compared to usual ICU care.

The clinical trial was conducted across 16 adult ICUs in 12 Swiss hospitals between May 2022 and January 2024. Critically ill patients' family members were enrolled if the patient had been in the ICU for at least 48 hours. ICUs were randomised 1:1 using minimisation. Follow-up occurred after ICU discharge, with data collection completed by February 2024. 

Intervention ICUs introduced a new family nurse role to provide relationship-focused support, engage with families, and facilitate interprofessional communication throughout the ICU stay. Control ICUs maintained standard care practices.

The primary outcome was family satisfaction with ICU care, measured using the Family Satisfaction with ICU survey (0–100 scale) after ICU discharge. Secondary outcomes included quality of family-clinician communication (1–5 scale) and cognitive and emotional support (14–70 scale), assessed using validated questionnaires.

Of 2,057 invited family members, 412 were enrolled in the intervention group and 473 in the control group (median age 54; 64% women; 48% partners). The intervention significantly improved overall family satisfaction with ICU care, with stronger effects on satisfaction with decision-making. It also improved communication and cognitive and emotional support. 

This nurse-led, multicomponent family support intervention modestly improved family satisfaction with ICU care, though the clinical significance of this benefit is uncertain due to already high baseline satisfaction in both study arms. However, the intervention notably enhanced communication quality and cognitive/emotional support, with effects exceeding the minimal clinically important difference.

Results align with previous trials like PARTNER, reinforcing that nurse-led, interprofessional support pathways can enhance ICU family care. The intervention did not consistently improve long-term family mental health outcomes, mirroring mixed findings from past studies. Family satisfaction may depend more on the combination of intervention components than on strict adherence to dose or frequency.

Improving communication and satisfaction, key mediators of post-ICU psychological outcomes, remains important, though further research is needed to determine the intervention's impact on broader family well-being and cost-effectiveness. Higher patient severity and planned admissions were associated with greater family satisfaction, but these findings warrant further investigation.

This nurse-led, interprofessional family support intervention in the ICU produced a small but statistically significant, and clinically uncertain, improvement in family satisfaction, along with stronger benefits in communication and emotional/cognitive support. These findings may inform efforts to enhance family-centred ICU care. Further validation across diverse populations and settings is needed, but incorporating the intervention into standard ICU practice may offer value.

Source: JAMA
Image Credit: iStock 
 

References:

Naef R, Jeitziner M, Riguzzi M et al. (2025) Nurse-Led Family Support Intervention for Families of Critically Ill Patients: The FICUS Cluster Randomized Clinical Trial. JAMA Intern Med.