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

Interventions to promote family member involvement in adult critical care settings: a systematic review

ObjectiveTo identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members.DesignMixed-method systematic review.Data sourcesBibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly.ResultsOut of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from −0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from −7.12 to 0.9), family well-being (mean difference ranged from −0.7 to −4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions.ConclusionsFuture interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members’ needs, readiness and preparedness for involvement.PROSPERO registrationCRD42018086325.

A Pilot Study of An Intervention to Increase Family Member Involvement in Nursing Home Care Plan Meetings

Background and Objectives: Many family members struggle to negotiate their aging relative’s care with nursing home staff, potentially leading to depression and other negative outcomes for residents’ families. This pilot study tested an intervention designed to empower residents’ family members to attend and participate in nursing home care plan meetings. Research Design and Methods: We conducted a small, randomized, controlled trial of the Families Involved in Nursing home Decision-making (FIND) intervention, which used web conferencing to facilitate family participation in care plan meetings. Results: Overall, FIND was feasible and acceptable. Family members who received the FIND intervention were more likely to experience decreased depressive symptoms than those who did not. Discussion and Implications: FIND is a promising approach to reduce depression among family members of nursing home residents. Findings support the need for a follow-up clinical trial.

Keterlibatan Anggota Keluarga Dalam Bisnis Dan Hubungannya Terhadap Kinerja Bisnis UMKM di Kota Padang

Purpose - This study aims to determine the relationship of family member involvement in business to the performance of SMEs businesses in the city of Padang.Methodology - The population in this study were allSMEs in the city of Padang. The sampling technique in this study is Non Probability Sampling. The number of samples is 100 respondents. The data analysis technique used is descriptive statistical analysis in the form of frequency distribution, percentage, cross tabulation, and chi-square test.Finding - From the results of this study, it can be seen that there is no significant relationship between the involvement of family members in the business towards the business performance of SMEs in Padang City. However, there is a significant relationship between the involvement of the number of family members and the dimensions of business performance, namely financial performance, the position of female family members significantly related to the dimensions of business performance, namely financial performance and preparing for the future. , the source of personal / friends' personal capital is significantly related to the dimensions of business performance, namely people development, the last source of bank capital is significantly related to the dimensions of business performance, namely financial performance.Keyword : Family member involvement, Business performance, family business

Role of Family Members in Pain Management in Adult Critical Care

This review describes family member involvement in intensive care unit pain assessment and management and generates implications for clinical practice, education, and future research. A literature review was performed in MEDLINE, PubMed, EMBASE, Cochrane, and CINAHL databases from their inception until April 30, 2019. Only 11 studies addressing the topic were identified, and the current quality of evidence is low. Family members can be involved in pain assessment by describing patients’ pain behaviors and in pain management by selecting and delivering nonpharmacological interventions tailored to patients’ needs, if the family members feel comfortable with this role. More-rigorous research is required to describe the role of family members in patients’ pain assessment and management. Advancing knowledge in this field could improve patients’ and family members’ experiences with pain assessment and management in the intensive care unit.

FAMILY CONFLICT: A WELL KEPT SECRET IN LATINO DEMENTIA CAREGIVING

The number of Latino older adults living with Alzheimer’s disease and related dementias (ADRD) could increase more than six-fold, from fewer than 200,000 in 2004 to more than 1.3 million by 2050 . One-third of Hispanic households report having at least one family caregiver (36%). 63% of Latino family caregivers are in high burden situations compared to 51% of non-Latino caregivers. Although in recent years research with Latino caregivers has increased, studies examining the family as a unit in a culture in which familismo is a central value, remain limited. The purpose of this study was to describe the experience of Latino families caring for loved ones living with ADRD along the illness trajectory. Group interviews were conducted with families caring for individuals in different stages of dementia. Interviews were conducted in English or Spanish, transcribed verbatim, and analyzed in the source language by bilingual investigators. In contrast to the numerous positive aspects of caregiving reported by individual Latino caregivers in previous studies, preliminary analysis of family group interviews revealed predominantly negative perceptions of the family caregiving experience. Families reported conflict between family members, feelings of resentment, lack of family member involvement, and uneven distribution of caregiving duties. The complex nature of fulfilling family duties as dictated by familismo appears to have idealistic and realistic consequences for families. Further exploration of Latino family dynamics in the context of dementia caregiving is needed.

Pengaruh Brand Loyalty, Brand Love, Brand Commitment Terhadap Willingness To Pay A Premium Price

The purpose of this research is to evaluate the influence of family and non-family member in the success of family business in trading business in Jabodetabek area. The population of this research is the successor of family business who does business in trading area. The sample of this research is the successor of family business in trading business in Jabodetabek area. Research methods that are used are questionnaire for 150 respondents. The analytical techniques that are used are classic assumption test, multiple regression analysis, t-test, F test and coefficient determination test using SPSS ver. 20.0. The result of classic assumption stated that this regression model is feasible to be used. The test result shows partially that even together there are still a positive and significance between family member and non-family member involvement for the success of family business. The result of the coefficient determination variable stated that the success of family business can be determined by family and non family member variable percentage that is 67,8% while the rest are determined by other variables.

How Involved Should They Be? Students with ASD in Postsecondary Settings and Their Family Members

We investigated the need for family member involvement for students with Autism Spectrum Disorder (ASD) in postsecondary settings. We also looked at the perceived needed and fulfilled roles of family members and if family member involvement resulted in positive outcomes for postsecondary students with ASD. We surveyed 211 postsecondary Disability Support Professionals (DSPs) through the AHEAD organization. Using a mixed methods approach including inductive content analysis, results primarily indicated that there is a need for family members to be involved non-academically with students with ASD. We discuss roles that DSPs think family members should fulfill versus roles that DSPs think that family members are actually fulfilling. It is apparent that DSPs think family member involvement is important but must be balanced with increasing the independence of students with ASD while enrolled in school.