Guidelines on Family-Centered Care for Adult ICUs: 2024
Citation:
Hwang DY, Oczkowski SJW, Lewis K, et al. Society of Critical Care Medicine guidelines on family-centered care for adult ICUs: 2024. Crit Care Med. 2025;53(2):e465-e482.
For staff in adult ICUs, providing family-centered care is an essential skill that affects important outcomes for both patients and families. The COVID-19 pandemic placed unprecedented strain on care of ICU families. Family engagement and support practices are still adjusting These guidelines review updated evidence for family support in adult ICUs, provide clear recommendations, and spotlight optimal family-centered care practices post-pandemic.
The guidelines panel issued one strong recommendation, 14 conditional recommendations, and two best practice statements related to family-centered care in adult ICUs. The guidelines panel reaffirmed the critical importance of liberalized family presence policies when possible and suggested options for family attendance on rounds and participation in bedside care. The panel suggested that ICUs provide support for families in the form of educational programs; ICU diaries; and mental health, bereavement, and spiritual support. The panel suggested the importance of providing structured communication for families and communication training for clinicians but did not recommend for or against any specific clinician-facing tools for family support or decision aids, based on current available evidence. The panel recommended that adult ICUs implement practices to systematically identify and reduce barriers to equitable critical care delivery for families and suggested that programs be developed to support the well-being of clinicians responsible for family support.
Guideline Type: Clinical
Related Resources:
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Download the Guidelines on Family-Centered Care for Adult ICUs Gap Analysis Toolkit |
Section:
Strength:
Identifier:
We recommend liberalized ICU family presence policies as the default practice in ICUs.
Certainty of evidence: Low
We suggest offering the option of families being present on rounds in the ICU.
Certainty of evidence: Very low
We suggest offering family participation in bedside care.
Certainty of evidence: Very low
We suggest offering family presence during resuscitation, with an assigned staff member to support the family.
Certainty of evidence: Low
We suggest providing educational programs for families of ICU patients to orient them to the ICU environment, ICU team, and ICU concepts.
Certainty of evidence: Moderate
We make no suggestion for or against specific tools relevant to family-centered ICU care designed for clinical teams.
Certainty of evidence: Low
We suggest providing ICU diaries for families of ICU patients.
Certainty of evidence: Low
We make no suggestion for or against any specific decision-making support tools for families of ICU patients.
Certainty of evidence: Low
We suggest providing bereavement support to families of patients who have died in the ICU.
Certainty of evidence: Low
We suggest identifying and supporting the mental health and psychological needs of families of ICU patients.
Certainty of evidence: Low
We suggest identifying and supporting the spiritual needs of families of ICU patients.
Certainty of evidence: Low
We recommend ICUs use family support zones or incorporate supportive features to meet family needs during patients’ ICU stays. Family needs described in the literature include rest spaces, areas for personal care, spaces to interact with staff for sensitive and confidential discussions, and room to sit comfortably at the bedside of the patient.
We recommend that ICUs implement practices to systematically identify and reduce barriers so as to promote equitable critical care delivery for patients’ families. Barriers described in the literature include language, varied cultural understandings and beliefs, and varied expectations around health and critical care delivery.
We suggest using standardized approaches for interdisciplinary family conferences and facilitation of communication in ICUs. Interventions include the use of specialized ICU staff who facilitate communication with families and regularly scheduled structured family meetings, including clinicians’ use of the value family statements, acknowledge emotions, listen, understand the patient as a person, elicit questions mnemonic.
Certainty of evidence: Low
We suggest ICUs provide communication skills training to clinicians, if local resources permit.
Certainty of evidence: Low
We suggest critical care trainees participate in high-fidelity (e.g., standardized actor) simulation communication education training programs.
Certainty of evidence: Low
We suggest structured programs to support clinicians in promoting the delivery of family-centered ICU care. Programs described in the literature have typically been multifaceted quality-improvement programs focused on family outcomes.
Certainty of evidence: Low
