Nurse-led continuity-oriented family support across the adult ICU trajectory: a systematic review and meta-analysis of PICS-F-related outcomes

Background Family members of adult ICU patients are at risk of post-intensive care syndrome-family (PICS-F), but the psychological effects and optimal timing of nurse-led support remain uncertain. Objective To evaluate nurse-led, continuity-oriented family support for PICS-F-related psychological outcomes and explore differences by intervention phase and nurse type. Methods PubMed, CINAHL, Web of Science, PsycINFO, Embase, and the Cochrane Library were searched from inception to May 2026. Randomized and quasi-experimental studies were eligible if they evaluated nurse-led family support in adult ICUs and assessed at least one family-level PICS-F psychological outcome. Short-term outcomes assessed from 2 weeks to 3 months after ICU discharge formed the primary analyses. Random-effects meta-analyses used Hedges' g standardized mean differences (SMDs). Subgroup analyses were conducted by primary intervention phase and nurse type. Risk of bias and certainty of evidence were assessed using validated tools and GRADE. Results Seventeen reports representing 16 independent studies and 3,887 family participants were included. Nurse-led support was not associated with short-term anxiety (SMD = −0.05, 95% CI −0.24 to 0.14; very low certainty), depression (SMD = −0.01, 95% CI −0.23 to 0.21; very low certainty), or post-traumatic stress disorder-related symptoms (SMD = 0.02, 95% CI −0.11 to 0.15; moderate certainty). In-ICU support was associated with lower depression scores (SMD = −0.40, 95% CI −0.67 to −0.12), although phase comparisons included few studies. No ICU transition study contributed an eligible short-term primary outcome. Nurse-type analyses showed no consistent differences. Conclusions Nurse-led, continuity-oriented family support was not associated with improvements in short-term PICS-F-related psychological outcomes. Current evidence does not identify an optimal intervention phase or nurse type. Implications for clinical practice Intervention timing should be considered, although the optimal phase remains uncertain. Nurse-led support may strengthen family-centred care, but persistent distress may require tailored psychological support and referral.