Family satisfaction with intensive care and preexisting family and patient characteristics: equivalence analysis of cross-sectional surveys

Objectives This study aims to demonstrate that family satisfaction with intensive care and decision-making is independent of sociodemographic family member and patient characteristics and the patient outcomes of mortality and length of stay. Methods Cross-sectional survey data from two independent samples of a total of 233 family members of adult patients treated in six ICUs of a Swiss university hospital were analyzed. The FS-ICU-24 questionnaire was used to measure the satisfaction of family members of intensive care unit (ICU) patients with ICU care and decision-making. Equivalence analysis methodology (TOST) was used to demonstrate the non-existence of moderate or greater associations between family satisfaction and routinely collected sociodemographic family member and patient characteristics and patient outcomes. Results The non-existence of such associations between family (age, gender, relationship, education, travel distance, previous ICU experience) or patient characteristics (age, sex, unplanned ICU admission) or outcomes (length of stay, death) and FS-ICU-24 or its subscales was demonstrated (pTOST ≤ 0.003). Conclusions Our results show that family satisfaction with ICU care is independent of sociodemographic family member and patient characteristics and patient outcomes that are available from routine documentation. It is highly unlikely that family satisfaction can be meaningfully predicted this way. Implications for Clinical Practice Early identification of families at risk of having an unsatisfactory ICU experience is important because (dis)satisfaction with care is a care-related factor for post-ICU anxiety, depression, and post-traumatic stress. Several studies have failed to demonstrate a relevant association with characteristics from routine documentation. Our study shows that this approach is unlikely to yield useful results. Therefore, it is crucial to focus research on care-related factors and their impact on family (dis)satisfaction and to build capacity for family-centered care in the ICU.