Family Support Intervention in Intensive Care Units (The Four Supports Study)

One in four elderly Americans die in or shortly after discharge from an intensive care unit.
An expanding body of literature documents that physician-family communication and
end-of-life care is poor in intensive care units. These deficiencies are associated with
high rates of adverse psychological outcomes among surrogates, physician-family conflict,
and life support decisions that may be inconsistent with patients' goals and preferences.
There is a lack on information on practical, generalizable interventions that effectively
improve this important aspect of care for elderly patients and their families.

The primary aim of this study is to evaluate the effectiveness of a multifaceted
communication intervention to improve psychological outcomes among family members of
critically ill patients, using a randomized, controlled trial design.

Inclusion Criteria for ICU Patients:

- must be unable to make treatment decisions for him/herself, as determined by the
patient's physicians.

- must have have either an APACHE II score of ≥ 25 or, for patients with a primary
neurologic diagnosis (e.g. intracranial hemorrhage, subdural hemorrhage, or
subarachnoid hemorrhage), physician estimate that the patient has at least a 50% risk
of long term, severe functional impairment

- must be 50 years old or greater.

Exclusion Criteria for ICU Patients:

- Patients who do not have surrogates or at least one family member who is willing to
participate in the study.

- Patients awaiting organ transplantation.