Barriers and facilitators to patient- and family-centered care in the ICU: A qualitative study of multiple stakeholder perspectives

BACKGROUND: Patient- and family-centered care (PFCC) aligns care with patients' and families' needs, values, and preferences. Although increasingly recognized in intensive care units (ICUs), implementation remains challenging due to the complex ICU environment. OBJECTIVES: To explore barriers and facilitators to ICU-PFCC from the perspectives of former ICU patients, family members, and ICU healthcare professionals. METHODS: Semi-structured focus groups with former ICU patients, family members, ICU nurses, nursing assistants and physicians from six hospitals in the Netherlands were conducted. Sessions were, audio-recorded, transcribed verbatim, and analyzed using directed content analysis with inductive coding. RESULTS: Six focus groups were conducted (four with health care professionals, two with patients and family members) after which data sufficiency was reached. Codes were organized under the four ICU-PFCC concepts: information sharing, collaboration, participation, dignity & respect. Barriers included illness severity, language and socioeconomic challenges, insufficient documentation, limited continuity, and resistance to cultural change, rigid protocols and high workload. Facilitators included clear, timely communication, consistent information sharing, personal connections, active family involvement, and preparation for ICU discharge. CLINICAL IMPLICATIONS: Improving ICU-PFCC requires addressing barriers such as fragmented documentation, rigid protocols, and limited information sharing . Facilitators like timely communication, personal engagement, and continuity of care should be embedded in daily routines. Nurses leadership is pivotal to sustaining interdisciplinary collaboration and cultural change. CONCLUSIONS: PFCC in the ICU cannot rely on individual efforts alone. Providing such care in clinical daily practice requires continuity of care and changes in communication practices, team culture, protocols, and organizational structures. For this interdisciplinary collaboration, with nurses in a leading role, are essential. As a result, gaps between healthcare professionals, patients and families can be breached and care delivered in genuine partnership.