Well-Being, Psychological Clinical Trial
Official title:
A Phase I Clinical Trial Evaluating the Impact of the Family Room App on Caregiver Well-being, Satisfaction, and Engagement in the Intensive Care Unit
BACKGROUND/PURPOSE: Engaging families in patient care during serious illness can enhance care quality, reduce social isolation, boost satisfaction, and lower healthcare costs. Active involvement of family caregivers in patient care remains limited because there are no evidence-based tools to guide clinicians on how to include them effectively. Therefore, the purpose of this study is to conduct a clinical trial that includes information developed while engaged in previous work related to the development and testing of a point-of-care technology that operationalizes caregiver involvement during acute hospitalization The investigators engaged in hypothesis driven customer discovery, then performed an iterative user centered design development and testing process, and now conclude with a clinical trial in the inpatient environment.
Status | Not yet recruiting |
Enrollment | 100 |
Est. completion date | October 31, 2025 |
Est. primary completion date | October 31, 2025 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 19 Years and older |
Eligibility | Inclusion Criteria: - Participants will be eligible if they are age 19 or older - At the patient's bedside during the patient's intensive care unit (ICU) admission and are considered the patient's legally authorized representative (LAR) or designated caregiver who is able to make medical decisions on their behalf. Exclusion Criteria: -Located at the patient's bedside but is not their legally authorized representative (LAR) or designated caregiver who is able to make medical decisions on their behalf |
Country | Name | City | State |
---|---|---|---|
United States | University of Nebraska Medical Center | Omaha | Nebraska |
Lead Sponsor | Collaborator |
---|---|
University of Nebraska | Gordon and Betty Moore Foundation |
United States,
Adler R, Mehta R. Catalyzing technology to support family caregiving. https://www.caregivin g.org/wp-content/uploads/2020/05/Catalyzing-Technology-to-Support-FamilyCaregiving_FINAL.pdf. Updated 2014. Accessed March 31, 2022.
Barello S, Castiglioni C, Bonanomi A, Graffigna G. The Caregiving Health Engagement Scale (CHE-s): development and initial validation of a new questionnaire for measuring family caregiver engagement in healthcare. BMC Public Health. 2019 Nov 27;19(1):1562. doi: 10.1186/s12889-019-7743-8. — View Citation
Blom H, Gustavsson C, Sundler AJ. Participation and support in intensive care as experienced by close relatives of patients: a phenomenological study. Intensive Crit Care Nurs. 2013 Feb;29(1):1-8. doi: 10.1016/j.iccn.2012.04.002. Epub 2012 Jun 28. — View Citation
Brown SM, Rozenblum R, Aboumatar H, Fagan MB, Milic M, Lee BS, Turner K, Frosch DL. Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med. 2015 Feb 1;191(3):358-60. doi: 10.1164/rccm.201410-1936LE. No abstract available. — View Citation
Choi J, Donahoe MP, Hoffman LA. Psychological and Physical Health in Family Caregivers of Intensive Care Unit Survivors: Current Knowledge and Future Research Strategies. J Korean Acad Nurs. 2016 Apr;46(2):159-67. doi: 10.4040/jkan.2016.46.2.159. — View Citation
Cook TD, Campbell DT. Quasi-Experimentation: Design and analysis for field settings. Boston: Houghton Mifflin Company; 1979.
Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Cox CE, Wunsch H, Wickline MA, Nunnally ME, Netzer G, Kentish-Barnes N, Sprung CL, Hartog CS, Coombs M, Gerritsen RT, Hopkins RO, Franck LS, Skrobik Y, Kon AA, Scruth EA, Harvey MA, Lewis-Newby M, White DB, Swoboda SM, Cooke CR, Levy MM, Azoulay E, Curtis JR. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017 Jan;45(1):103-128. doi: 10.1097/CCM.0000000000002169. — View Citation
Epstein-Lubow G, Gaudiano BA, Hinckley M, Salloway S, Miller IW. Evidence for the validity of the American Medical Association's caregiver self-assessment questionnaire as a screening measure for depression. J Am Geriatr Soc. 2010 Feb;58(2):387-8. doi: 10.1111/j.1532-5415.2009.02701.x. No abstract available. — View Citation
Figma. Accessed November 9, 2023. https://www.figma.com/
Goldfarb M, Debigare S, Foster N, Soboleva N, Desrochers F, Craigie L, Burns KEA. Development of a Family Engagement Measure for the Intensive Care Unit. CJC Open. 2022 Aug 5;4(11):1006-1011. doi: 10.1016/j.cjco.2022.07.015. eCollection 2022 Nov. — View Citation
Health Information and Management Systems Society. Caregiver burnout: How technology brings help and hope. https://www.himss.org/resources/caregiver-burnout-how-technologybrings-help-and-hope. Updated 2020. Accessed March 31, 2022
Hetland B, Bach C, Castner JP, et al. A randomized clinical trial to test a mobile application that supports family caregiver participation in patient care in the intensive care unit. Am J Respir Crit Care Med. 2023;207:A2507.
Hetland B, Bach C, Grotts E, et al. Development of a Mobile Application to Promote Family Caregiver Engagement in the Assessment and Management of Patient Symptoms During Mechanical Ventilation in the Intensive Care Unit (ICU). Am J Respir Crit Care Med. 2021;203:A1090.
Hetland B, Hickman R, McAndrew N, Daly B. Factors Influencing Active Family Engagement in Care Among Critical Care Nurses. AACN Adv Crit Care. 2017 Summer;28(2):160-170. doi: 10.4037/aacnacc2017118. — View Citation
Hetland B, McAndrew N, Perazzo J, Hickman R. A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses. Intensive Crit Care Nurs. 2018 Feb;44:67-75. doi: 10.1016/j.iccn.2017.08.008. Epub 2017 Nov 21. — View Citation
Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Pozehl BJ, Heusinkvelt JM, Camenzind CE. Family Caregiver Preferences and Contributions Related to Patient Care in the ICU. West J Nurs Res. 2022 Mar;44(3):214-226. doi: 10.1177/01939459211062954. Epub 2021 Dec 14. — View Citation
Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Turnbull AE, Pozehl BJ, Heusinkvelt JM. Relationships among Demographic, Clinical, and Psychological Factors Associated with Family Caregiver Readiness to Participate in Intensive Care Unit Care. Ann Am Thorac Soc. 2022 Nov;19(11):1881-1891. doi: 10.1513/AnnalsATS.202106-651OC. — View Citation
Hetland BD, Pozehl B, Kupzyk K, et al. The impact of family caregiver psychophysiological characteristics on the caregiver role in the intensive care unit. Am J Respir Crit Care Med. https://doi.org/10.1164/ajrccmconference.2019.199.1_MeetingAbstracts.A4361
Irmansyah I, Dharmono S, Maramis A, Minas H. Determinants of psychological morbidity in survivors of the earthquake and tsunami in Aceh and Nias. Int J Ment Health Syst. 2010 Apr 27;4(1):8. doi: 10.1186/1752-4458-4-8. — View Citation
Kleinpell R, Heyland DK, Lipman J, Sprung CL, Levy M, Mer M, Koh Y, Davidson J, Taha A, Curtis JR; Council of the World Federation of Societies of Intensive and Critical Care Medicine. Patient and family engagement in the ICU: Report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2018 Dec;48:251-256. doi: 10.1016/j.jcrc.2018.09.006. Epub 2018 Sep 8. — View Citation
Kleinpell R, Zimmerman J, Vermoch KL, Harmon LA, Vondracek H, Hamilton R, Hanson B, Hwang DY. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Crit Care Med. 2019 Dec;47(12):1692-1698. doi: 10.1097/CCM.0000000000004009. — View Citation
Lindeman DA, Kim KK, Gladstone C, Apesoa-Varano EC. Technology and Caregiving: Emerging Interventions and Directions for Research. Gerontologist. 2020 Feb 14;60(Suppl 1):S41-S49. doi: 10.1093/geront/gnz178. — View Citation
McAndrew NS, Jerofke-Owen T, Fortney CA, Costa DK, Hetland B, Guttormson J, Harding E. Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs. Nurs Crit Care. 2022 May;27(3):296-325. doi: 10.1111/nicc.12564. Epub 2020 Oct 21. — View Citation
Miro. Accessed November 9, 2023. https://miro.com/
Mitchell M, Chaboyer W, Burmeister E, Foster M. Positive effects of a nursing intervention on family-centered care in adult critical care. Am J Crit Care. 2009 Nov;18(6):543-52; quiz 553. doi: 10.4037/ajcc2009226. — View Citation
Mitchell ML, Coyer F, Kean S, Stone R, Murfield J, Dwan T. Patient, family-centred care interventions within the adult ICU setting: An integrative review. Aust Crit Care. 2016 Nov;29(4):179-193. doi: 10.1016/j.aucc.2016.08.002. Epub 2016 Sep 1. — View Citation
Mitchell ML, Kean S, Rattray JE, Hull AM, Davis C, Murfield JE, Aitken LM. A family intervention to reduce delirium in hospitalised ICU patients: A feasibility randomised controlled trial. Intensive Crit Care Nurs. 2017 Jun;40:77-84. doi: 10.1016/j.iccn.2017.01.001. Epub 2017 Feb 27. — View Citation
Notably. Accessed November 9, 2023. https://www.notably.ai/
Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect. 2016 Dec;19(6):1183-1202. doi: 10.1111/hex.12402. Epub 2015 Sep 7. — View Citation
Puntillo K, Arai SR, Cooper BA, Stotts NA, Nelson JE. A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients. Intensive Care Med. 2014 Sep;40(9):1295-302. doi: 10.1007/s00134-014-3339-z. Epub 2014 Jun 4. — View Citation
Puntillo KA, Arai S, Cohen NH, Gropper MA, Neuhaus J, Paul SM, Miaskowski C. Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med. 2010 Nov;38(11):2155-60. doi: 10.1097/CCM.0b013e3181f267ee. — View Citation
Ryan P, Sawin KJ. The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes. Nurs Outlook. 2009 Jul-Aug;57(4):217-225.e6. doi: 10.1016/j.outlook.2008.10.004. — View Citation
Stoyanov SR, Hides L, Kavanagh DJ, Wilson H. Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS). JMIR Mhealth Uhealth. 2016 Jun 10;4(2):e72. doi: 10.2196/mhealth.5849. — View Citation
Tracy MF, Chlan L. Nonpharmacological interventions to manage common symptoms in patients receiving mechanical ventilation. Crit Care Nurse. 2011 Jun;31(3):19-28. doi: 10.4037/ccn2011653. — View Citation
Vaishnavi S, Connor K, Davidson JR. An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials. Psychiatry Res. 2007 Aug 30;152(2-3):293-7. doi: 10.1016/j.psychres.2007.01.006. Epub 2007 Apr 25. — View Citation
van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Reported burden on informal caregivers of ICU survivors: a literature review. Crit Care. 2016 Jan 21;20:16. doi: 10.1186/s13054-016-1185-9. — View Citation
Weis A, Pohlmann S, Poss-Doering R, Strauss B, Ullrich C, Hofmann H, Ose D, Winkler EC, Szecsenyi J, Wensing M. Caregivers' role in using a personal electronic health record: a qualitative study of cancer patients and caregivers in Germany. BMC Med Inform Decis Mak. 2020 Jul 13;20(1):158. doi: 10.1186/s12911-020-01172-4. — View Citation
Wilk, C. Development and Psychometric Performance of the Family Willingness for Caregiving Scale (FWCS). [Doctoral dissertation]. Kent, OH: Kent State; 2023.
Yen PY, Kellye M, Lopetegui M, Saha A, Loversidge J, Chipps EM, Gallagher-Ford L, Buck J. Nurses' Time Allocation and Multitasking of Nursing Activities: A Time Motion Study. AMIA Annu Symp Proc. 2018 Dec 5;2018:1137-1146. eCollection 2018. — View Citation
Young QR, Nguyen M, Roth S, Broadberry A, Mackay MH. Single-item measures for depression and anxiety: Validation of the Screening Tool for Psychological Distress in an inpatient cardiology setting. Eur J Cardiovasc Nurs. 2015 Dec;14(6):544-51. doi: 10.1177/1474515114548649. Epub 2014 Aug 19. — View Citation
* Note: There are 40 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Caregiver Engagement-Practical Aspects-FAMily Engagement (FAME) Tool | The FAMily Engagement (FAME) questionnaire is an instrument developed to assess current family engagement practice. Items address key principles of family-centered care, such as dignity and respect, information sharing, participation, and collaboration. They also address family engagement domains, including family presence, family needs, communication and education, decision making, and direct care. A five-point Likert scale (1=strongly agree, 2=agree, 3=neutral, 4=disagree, 5=strongly disagree) is used for responses, which are then transformed to a 0-100 scoring system, with higher scores indicating greater engagement in care and lower scores indicating lesser engagement in care. The overall engagement score is calculated by dividing the sum of the scores by the number of questions answered, with the result ranging from 0-100. The FAME tool has high construct validity and can be completed in 3.33 minutes by family members. | Taken at study enrollment and within 48 hours of ICU discharge | |
Primary | Daily activity within the Family Room App | Measuring the daily activity logged within the application at the bedside. Only being measured in the experimental group. | Daily from enrollment in study until ICU discharge, assessed up to 16 months | |
Primary | Daily Patient Symptoms- Severity of Illness- Apache II | Taken from the electronic health record. APACHE II (Acute Physiology and Chronic Health Evaluation II) is a severity-of-disease classification system used in the ICU. An integer score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death. | Daily from enrollment in the study until ICU discharge, assessed up to 16 months | |
Primary | Daily Patient Symptoms- Presence of lines, tubes, equipment | Taken from the electronic health record. Count of number of lines, tubes, equipment present on ICU patient | Daily from enrollment in the study until ICU discharge, assessed up to 16 months | |
Primary | Daily Patient Symptoms- Glasgow Coma Scale (GCS) | Nurse documentation of level of consciousness in the electronic health record. The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and verbal responses.The total score ranges between 3 and 15, with 3 being the worst and 15 being the highest. | Daily from enrollment in the study until ICU discharge, assessed up to 16 months | |
Primary | Daily Patient Symptoms- Pain | Nurse documentation of patient pain in the electronic health record. Pain scores can range for 0 being no pain to 10 being the worst pain. | Daily from enrollment in the study until ICU discharge, assessed up to 16 months | |
Primary | Daily Patient Symptoms- Richmond Agitation-Sedation Scale (RASS) | Nurse documentation of patient agitation in the electronic health record. Documented with a RASS score (richmond agitation-sedation scale). Range of scale is a ten point scale, with -5 (being unarousable) to +4 (being combative). | Daily from enrollment in the study until ICU discharge, assessed up to 16 months | |
Primary | Daily Patient Symptoms- CAM-ICU | Confusion Assessment Method for the ICU (CAM-ICU). Taken from the electric health record. CAM-ICU is a valid and reliable delirium assessment tool. CAM-ICU is a tool to assess for the presence of delirium in ICU patients who are unable to talk. It involves a sedation assessment and a confusion assessment. The confusion assessment evaluates four features: acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness. A patient is considered to be confused if they have feature 1 plus 2 and either 3 or 4 present. The CAM-ICU score ranges from 0 to 4, with 4 being the most severe. | Daily from enrollment in the study until ICU discharge, assessed up to 16 months | |
Secondary | Caregiver well-being- Screening Tool for Psychological Distress (STOP-D) | 5 item screening tool which provides severity scores for each of the common psychosocial problem areas: depression, anxiety, stress, anger, and low social support. A recent study showed that the STOP-D is a valid screening tool for depression and anxiety when used in inpatient settings. | Taken at study enrollment, then every 48 hours while patient is admitted to the ICU, and within 48 hours of ICU discharge, up to study completion or about 16 months | |
Secondary | Caregiver well-being- Caregiver Self-Assessment Questionnaire | 18-item, caregiver self-report measure was devised by the American Medical Association as a means of helping physicians assess the stress-levels of family caregivers. Caregivers are asked to respond either "Yes" or "No" to a series of statements, simple scoring system allows family caregiver themselves to score their results and to determine whether or not they are highly stressed. Scores between 0-16 for "yes" responses, with a higher number meaning more stress. The questionnaire was normed on a small national sample of family caregivers (n=60); the reliability coefficient alpha was .78. Specific items were found to be predictive of caregiver stress. | Taken at study enrollment and within 48 hours of ICU discharge | |
Secondary | Caregiver Engagement -Psychological Experience- Caregiving Health Engagement Scale (CHE-s) | 7 item multidimensional scale proposed to evaluate the impact of burden on different aspects of a caregivers life. A recent validation study showed solid evidence for the internal consistency and concurrent validity of the CHE-s. The CHE is scored based on a Likert-type scale. Caregivers respond to a series of statements, indicating their level of agreement or disagreement. The total score reflects the caregiver's overall engagement in healthcare. Higher scores indicate greater engagement. | Taken at study enrollment and within 48 hours of ICU discharge | |
Secondary | Caregiver Resilience- Connor-Davidson Resilience Scale (CD-RISC2) | 2 item instrument that measures resilience, specifically as it relates to bounce back and adaptability. Good test-retest reliability, convergent validity, and divergent validity. Answers are on a 5-point scale response, not true at all=0, rarely true=1, sometimes true=2, often true=3, and true nearly all of the time=4. Higher scores indicating greater perceived resilience. | Taken at study enrollment | |
Secondary | Caregiver Preparedness-Preparedness for Caregiving Scale | The Preparedness for Caregiving Scale is a caregiver self-rated instrument that consists of ten items that asks caregivers how well prepared they believe they are for multiple domains of caregiving. Preparedness is defined as perceived readiness for multiple domains of the caregiving role such as providing physical care, providing emotional support, setting up in-home support services, and dealing with the stress of caregiving. Responses are rated on a 5-point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared). The scale is scored by calculating the mean of all items answered with a score range of 0 to 4. The higher the score the more prepared the caregiver feels for caregiving; the lower the score the less prepared the caregiver feels. | Taken within 48 hours of ICU discharge |