Abstract
Context
Critical illness of a family member is associated with high emotional and spiritual
distress and difficult medical decisions.
Objectives
To determine if a semistructured spiritual care intervention improves the well-being
of family surrogate decision makers in intensive care (ICU) settings.
Methods
This study is a randomized, allocation-concealed, parallel group, usual care-controlled,
single-blind trial of patient/surrogate dyads in five ICUs in one Midwest, academic
medical center. Patients were 18 and older admitted to the ICU and unable to make
medical decisions. The intervention involved proactive contact from the chaplain,
scheduled, semi-structured visits, weekly follow-up, and bereavement calls. The control
group received usual care. The primary endpoint was the surrogate's anxiety (Generalized
Anxiety Disorders-7 scale), six to eight weeks after discharge.
Results
Of 192 patient/surrogate dyads enrolled, 128 completed outcome assessments. At follow-up,
anxiety in the intervention group was lower than control (median score 1 (interquartile
range 0,6) vs. 4 (1,9), P = 0.0057). The proportion of patients with a minimal clinically important difference
(MCID) in anxiety of 2+ was 65.2% in the intervention group vs. 49.2% in control.
The odds of an MCID remained higher in adjusted analysis (Odds Ratio 3.11, 95% confidence
interval 1.18, 8.21; P = 0.0218) The adjusted odds of an MCID were higher for spiritual well-being (OR 3.79,
CI 1.41,10.17; P = 0.0081). Satisfaction with spiritual care was also higher (adjusted mean 3.5 ±
0.4 vs. 2.9 ± 0.1); P < .0001).
Conclusions
Proactive, semistructured spiritual care delivered by chaplains improves well-being
for ICU surrogates. Results provide evidence for inclusion of chaplains in palliative
and intensive care teams.
Key Words
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Article info
Publication history
Published online: December 13, 2022
Accepted:
December 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Registration: ClinicalTrials.gov number, NCT03702634
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
