Multi-component Family Support Tool Intervention (FST)

The Family Support Tool intervention is designed to help families navigate the emotional, psychological, and cognitive complexities of being a surrogate for an incapacitated critically ill patient and also to enhance the timeliness and quality of clinician-family communication. The intervention consists of three components:

• Proactive clinician-family meetings within 48 hours of enrollment and every 5-7 days thereafter.
• Family members complete sections of an interactive web-based tool upon study enrollment, before family meetings, and any other time they wish. Family members can access the tool anywhere via computer, tablet, or mobile phone. The first section of the tool is completed on the first day of study enrollment and contains: video messages supporting families including stories from other families and their experiences and coping strategies, tips on self-care and links to hospital resources. The second and third sections of the FST are completed before scheduled clinician-family meetings on study day 2-3 and again 5-7 days later. These sections of the tool contain: videos detailing what to expect during family meetings, interactive exercises and prompts about patient values, prognosis, care expectations and treatment leanings to help prepare for family meetings. The study team will provide families a printed summary sheet of their main questions for the ICU team that they are encouraged to bring to the family meeting.
• Before each scheduled family meeting the ICU team receives a written report that summarizes the family's main questions and concerns, information about the patient's values and preferences, surrogates' prognostic expectations, and a visual display of their unmet PC needs.

INCLUSION

Patient

• Age ≥18
• Lack of decision-making capacity as determined by clinical examination by the attending physician or designee
• Clinical indication of at least 40% risk of death or ≥40% chance of new, severe long-term functional impairment (needs assistance with ≥ 2 ADLs), as judged by the patient's attending physician or designee

Surrogate

• The primary surrogate is determined by the patient's advance directive or, if no directive exists, by following the hierarchy of surrogates codified in state law.
• Up to 3 additional surrogates

Clinician

• Patient's primary attending (or their designee)

EXCLUSION

Patient

• Lack of a surrogate decision maker
• Family not available for study
• Imminent death (within 24 hours); goals of care are already "comfort measures only"; decision to withdraw life support has already been made
• Currently participating in a competing research study that does not allow co-enrollment
• Incarcerated or on an involuntary hold
• Died prior to enrollment
• Discharged prior to enrollment
• Regained capacity prior to enrollment
• Physician declined patient's participation
• Physician and designee declined own participation
• Patient does not meet inclusion criteria within 5 days of ICU admission
• MD expects transfer orders will be written or the patient will be transferred within 36 hours of screening
• Greater than 5 ICU days during the current hospitalization

Surrogate

• Age <18 years
• Cannot read or understand English
• Cannot complete questionnaires due to physical or cognitive limitations
• Has no access to or cannot travel to access the internet