Assessing burden in families of critical care patients

OBJECTIVE: To provide critical care clinicians with information on validated instruments for assessing burden in families of critical care patients. DATA SOURCES: PubMed (1979-2009). STUDY SELECTION: We included all quantitative studies that used a validated instrument to evaluate the prevalence of, and risk factors for, burden on families. DATA EXTRACTION AND SYNTHESIS: We extracted the descriptions of the instruments used and the main results. Family burden after critical illness can be detected reliably and requires preventive strategies and specific treatments. Using simple face-to-face interviews, intensivists can learn to detect poor comprehension and its determinants. Instruments for detecting symptoms of anxiety, depression, or stress can be used reliably even by physicians with no psychiatric training. For some symptoms, the evaluation should take place at a distance from intensive care unit discharge or death. Experience with families of patients who died in the intensive care unit and data from the literature have prompted studies of bereaved family members and the development of interventions aimed at decreasing guilt and preventing complicated grief. CONCLUSIONS: We believe that burden on families should be assessed routinely. In clinical studies, using markers for burden measured by validated tools may provide further evidence that effective communication and efforts to detect and to prevent symptoms of stress, anxiety, or depression provide valuable benefits to families.