Implications for Australian practice of North American guidelines for the support of the family in patient-centred intensive care

SummaryPatient-centred care, in which health care professionals inform patients and families, maintain active involvement in decision making, coordinate care across disciplines, provide families with physical comfort and emotional support and ensure care is culturally sensitive, is recommended over clinician- or disease-centred care for better patient outcomes. Patients in intensive care are often too ill to participate in communication and decision making, so the patient's family should be involved in communication and decision making about the patient's care. The Society of Critical Care Medicine published clinical practice guidelines for the support of the family in the patient-centred intensive care unit. The purpose of this paper is to assess whether the 42 recommendations in the guidelines are valid and applicable in Australia. We used a recognised framework for evaluation of clinical practice guidelines. It was found that the guidelines were developed systematically using accepted methods of guideline development as much as possible. An extensive literature review was conducted and publications containing all levels of evidence were considered for inclusion. There were some weaknesses in the guideline development, especially lack of consultation with patients and families and a lack of high-level evidence, however the authors have provided comprehensive recommendations to guide all aspects of patient-centred care. We conclude that the recommendations are largely applicable to the patients and families receiving treatment and support within intensive care units in Australia. Where strong evidence is lacking, the recommendations should be a stimulus to conduct studies that test interventions that may benefit intensive care patients, their families, and intensive care staff.