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Crit Care Med. 2017 Jan;45(1):103-128.

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

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1Department of Education, Development and Research, University of California, San Diego Health, San Diego, CA. 2Department of Anesthesiology and Critical Care Medicine, Department of Oncology and the Palliative Care Program in the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. 3Department of Health, Behavior, and Society in the Johns Hopkins Bloom berg School of Public Health, The Johns Hopkins Hospital, Baltimore, MD. 4Cambia Palliative Care Center of Excellence, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 5Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA. 7Division of Pulmonary, Allergy, and Critical Care Medicine, Fostering Improvement in End-of-Life Decision Science Program, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 8Division of Pulmonary and Critical Care Medicine, Program to Support People and Enhance Recovery, Duke University, Durham, NC. 9Department of Critical Care Medicine Sunnybrook Health Sciences Centre, Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 10The Library, University of California, San Diego, CA. 11Departments of Anesthesiology, Perioperative Care and Pain Medicine; Neurology; Surgery and Medicine, University of Chicago, Chicago, IL. 12New York University, New York, NY. 13Division of Pulmonary and Critical Care Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. 14Famiréa Research Group, Medical Intensive Care, Hôpital Saint Louis, Paris, France. 15Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. 16Department of Anaesthesiology and Intensive Care Medicine, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. 17Graduate School of Nursing Midwifery and Health, Victoria University of Wellington; Capital and Coast District Health Board, Wellington, New Zealand. 18Center of Intensive Care, Medisch Centrum, Leeuwarden, The Netherlands. 19Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT. 20Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT. 21Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA. 22Department of Medicine, MSc McGill University, Montreal, QC, Canada. 23Naval Medical Center San Diego and University of California San Diego, San Diego, CA. 24Quality and Regulatory Services, Kaiser Permanente, Oakland, CA. 25Critical Care Educator and Consultant, Lake Tahoe, Nevada. 26Divisions of Pediatric Cardiac Critical Care Medicine and Pediatric Bioethics, Department of Pediatrics, University of Washington, Seattle Childrens Hospital, Seattle, WA. 27Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 28Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD. 29University of Michigan Hospitals, North Campus Research Complex, Ann Arbor, MI. 30The Warren Alpert School at Brown University, Providence, RI.



To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.


We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development.


The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice.


These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.

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