Associations Between Family Member Involvement and Outcomes of Patients Admitted to the Intensive Care Unit: Retrospective Cohort Study (Preprint)

BACKGROUND Little is known about family member involvement, by relationship status, for patients treated in the intensive care unit (ICU). OBJECTIVE Using documentation of family interactions in clinical notes, we examined associations between child and spousal involvement and ICU patient outcomes, including goals of care conversations (GOCC), limitations in life-sustaining therapy (LLST), and 3-month mortality. METHODS Using a retrospective cohort design, the study included a total of 858 adult patients treated between 2008-2012 in the medical intensive care unit at a tertiary care center in the northeastern United States. Clinical notes generated within the first 48 hours of admission to the ICU were used with standard machine learning methods to predict patient outcomes. We used natural language processing methods to identify family-related documentation and abstracted sociodemographic and clinical characteristics from the medical record. RESULTS Most patients were white (75.8%, n = 650/858), 50.9% (n = 437/858) were male, 55.8% (n = 479/858) were married, and the median age was 68.4 (IQR 56.5-79.4) years. Most patients had documented GOCC (75.9%, n=651/858). In adjusted regression analyses, child involvement (OR = 0.81, P = .41) and child plus spouse involvement (OR = 1.28, P = .30) were not associated with GOCC compared to spouse involvement. Child involvement was not associated with LLST compared to spouse involvement (OR = 1.49, P = .13). However, child plus spouse involvement was associated with LLST (OR = 1.60, P = .04). Compared to spouse involvement, there were no significant differences in 3-month mortality by family member type, including child plus spouse involvement (OR = 1.38, P = .13) and child involvement (OR = 1.47, P = .12). CONCLUSIONS Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Early child plus spouse involvement in decision-making within the first 48 hours of ICU admission was associated with LLST, suggesting that families may prefer joint decision-making. Including all available family members early in ICU care may ease the limitations of life-sustaining treatments. CLINICALTRIAL Not applicable