Measuring satisfaction in family members of critically ill cancer patients in Brazil

Factors associated with family satisfaction in the adult intensive care unit: A literature review

OBJECTIVE

The objective of this study was to identify and summarise factors associated with family satisfaction among family members of adult intensive care unit (ICU) patients.

REVIEW METHODS/DATA SOURCES

A search was conducted from inception to October 2020 in the following databases: PubMed, Scopus, EMBASE, CINAHL Plus, ProQuest Health Management, PsycINFO, LILACS, and SciELO. Studies reporting the questionnaire's items or dimensions as family satisfaction factors, studies dichotomising family satisfaction outcome, and those involving family members of neonatal, paediatric, palliative, and end-of-life patients were excluded. Quality of the studies was examined through a modified approach to the Consolidated Standards for Reporting Trials (CONSORT). Reported factors were classified as family member, patient, or provider/organisation related.

RESULTS

The search yielded 26 articles reporting factors associated with family satisfaction in the ICU. Regarding study quality, 19.2% were classified as high-quality studies. Family member-related variables such as educational level, gender, and kinship to the patient showed divergent associations with family satisfaction. Within patient-related variables, the severity of illness was positively associated with family satisfaction. Factors related to healthcare providers and organisations were reported only in 26.9% of the studies.

CONCLUSIONS

A broad number of factors associated with family satisfaction in the ICU were found in this review. However, few nonmodifiable factors related to the family members and the patient showed a significant and consistent association with family satisfaction. Evidence on factors related to healthcare providers was scarce. Gaps in knowledge regarding family satisfaction in the ICU, including methodological issues that impair the validity of the findings, were identified. Future studies should address these limitations to accurately identify factors that impact family satisfaction in the ICU.

Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout

OBJECTIVE

To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors.

BACKGROUND

There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied.

METHODS

Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory.

RESULTS

Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02).

CONCLUSIONS

Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.

Satisfaction of family members of critically ill patients admitted to a public hospital intensive care unit and correlated factors

Objective

To analyze the satisfaction, medical situation understanding and symptoms of anxiety and depression in family members of patients admitted to the intensive care unit.

Methods

The family members of patients who were hospitalized for ≥ 72 hours were invited to participate in the study, which was performed in a public hospital. Questionnaires were answered to assess the understanding of the diagnosis, treatment and prognosis, and the support received in the intensive care unit. The family needs were also evaluated using a modified version of the Critical Care Family Needs Inventory (CCFNI). The Hospital Anxiety and Depression Scale (HADS) was used to assess the symptoms of anxiety and depression.

Results

A total of 35 family members were interviewed within the patients' first week of stay in the intensive care unit. Most patients (57.1%) were male, aged 54 ± 19 years. Sepsis was the main reason for admission to the intensive care unit (40%); the median of the Simplified Acute Physiology Score (SAPS) 3 was 68 (48 - 77), and 51.4% of the patients died in the intensive care unit. The majority of the family members were female (74.3%) and were sons or daughters of patients (54.3%), with a mean age of 43.2 ± 14 years. Overall, 77.1% of the family members were satisfied with the intensive care unit. A total of 37.1% of the family members did not understand the prognosis. Receiving clear and complete information in the intensive care unit and the doctor being accessible were factors that were significantly correlated with the overall family satisfaction. The prevalence of symptoms of anxiety (60%) and depression (54.3%) in the family members was high.

Conclusion

The emotional distress of family members is high during a patient's hospitalization in the intensive care unit, although satisfaction is also high. Clear and complete information provided by the intensivist and the support received in the intensive care unit are significantly correlated with the satisfaction of family members in a public hospital.

Statistical analysis plan for a cluster-randomized crossover trial comparing the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units (the ICU Visits Study)

BACKGROUND

Most adult intensive care units (ICUs) worldwide adopt restrictive family visitation models (RFVMs). However, evidence, mostly from non-randomized studies, suggests that flexible adult ICU visiting hours are safe policies that can result in benefits such as prevention of delirium and increase in satisfaction with care. Accordingly, the ICU Visits Study was designed to compare the effectiveness and safety of a flexible family visitation model (FFVM) vs. an RFVM on delirium prevention among ICU patients, and also to analyze its potential effects on family members and ICU professionals.

METHODS/DESIGN

The ICU Visits Study is a cluster-randomized crossover trial which compares an FFVM (12 consecutive ICU visiting hours per day) with an RFVM (< 4.5 ICU visiting hours per day) in 40 Brazilian adult ICUs. Participant ICUs are randomly assigned to either an FFVM or RFVM in a 1:1 ratio. After enrollment and follow-up of 25 patients, each ICU is crossed over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome is the cumulative incidence of delirium measured by the Confusion Assessment Method for the ICU. Secondary and tertiary outcomes include relevant measures of effectiveness and safety of ICU visiting policies among patients, family members, and ICU professionals. Herein, we describe all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of this study. This pre-specified statistical analysis plan was written and submitted without knowledge of the study data.

DISCUSSION

This a priori statistical analysis plan aims to enhance the transparency of our study, facilitating unbiased analyses of ICU visit study data, and provide guidance for statistical analysis for groups conducting studies in the same field.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02932358 . Registered on 11 October 2016.

Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study)

INTRODUCTION

Flexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals.

METHODS AND ANALYSIS

A cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals.

ETHICS AND DISSEMINATION

The study protocol has been approved by the research ethics committee of all participant institutions. We aim to disseminate the findings through conferences and peer-reviewed journals.

TRIAL REGISTRATION

NCT02932358.

Effects of Resourcefulness on Sleep Disturbances, Anxiety, and Depressive symptoms in Family Members of Intensive Care Unit Patients

The study aimed to investigate the relationships among psychological distresses, resourcefulness, sleep disturbances, anxiety and depressive symptoms in family members of intensive care unit (ICU) patients. A cross-sectional, descriptive correlational design was employed. Using structural equation modeling (SEM) approach, relationships among factors, mediators, and outcomes were analyzed. The SEM explained 59% of the variances in depressive symptoms and 36% in anxiety. Family members with greater learned resourcefulness had fewer sleep disturbances, depressive and anxiety symptoms. Nursing professionals need to detect psychiatric disease of family members and must be especially vigilant with people who have low resourcefulness and sleep disturbances.

Intensive care unit visitation policies in Brazil: a multicenter survey

Objective

This study aimed to determine which visitation policy was the most predominant in Brazilian intensive care units and what amenities were provided to visitors.

Methods

Eight hundred invitations were sent to the e-mail addresses of intensivist physicians and nurses who were listed in the research groups of the Brazilian Association of Intensive Care Network and the Brazilian Research in Intensive Care Network. The e-mail contained a link to a 33-item questionnaire about the profile of their intensive care unit.

Results

One hundred sixty-two questionnaires from intensive care units located in all regions of the country, but predominantly in the Southeast and South (58% and 16%), were included in the study. Only 2.6% of the intensive care units reported having liberal visitation policies, while 45.1% of the intensive care units allowed 2 visitation periods and 69.1% allowed 31-60 minutes of visitation per period. In special situations, such as end-of-life cases, 98.7% of them allowed flexible visitation. About half of them (50.8%) did not offer any bedside amenities for visitors. Only 46.9% of the intensive care units had a family meeting room, and 37% did not have a waiting room.

Conclusion

Restrictive visitation policies are predominant in Brazilian intensive care units, with most of them allowing just two periods of visitation per day. There is also a lack of amenities for visitors.

Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties

OBJECTIVES

To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties.

DATA SOURCES

We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013.

STUDY SELECTION

Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility.

DATA EXTRACTION

Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies.

DATA SYNTHESIS

The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce.

CONCLUSIONS

Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.

Impact of fast-track discharge from cardiothoracic intensive care on family satisfaction

Background

Dissatisfaction with the intensive care unit may threaten medical care. Clarifying treatment preferences can be useful in these settings, where physician direction may influence decision making and therefore medical treatment. This study aimed to evaluate whether fast-track discharge from intensive care units affects the satisfaction of family members.

Methods

We used a single-center non-randomized trial, with all eligible family members involved. To evaluate family satisfaction, we used the Society of Critical Care Family Needs Assessment questionnaire (SCCMFNAQ). We hypothesized that those discharged within 24 h of intensive care unit admission and their families would have higher levels of satisfaction. Patients were scored using the therapeutic interventions scoring system (TISS) and additive EuroSCORE.

Results

Two-hundred fifty-five family members were enrolled. The mean patient age was 53 years, and 92 % were male. The median satisfaction level among family members was 17.9 (range 14–31). Patients were divided into two groups, one receiving fast-track discharge (116 patients), and one whose members stayed longer (139 patients). The overall satisfaction was affected significantly by quality of the delivered care and dissatisfaction increased by lack of comfort in hospital settings, including the waiting room. No significant differences were seen between the two groups for overall satisfaction (p = 0.546) and individual components of the questionnaire. Higher satisfaction was linked to higher levels of education among family members (p = 0.045) and information being relayed by a senior physician p = 0.03 (two-tailed test).

Conclusions

Fast-track discharge from intensive care did not influence family satisfaction as hypothesized. Satisfaction relied on family members’ level of education and the level of seniority of the physician relaying information.

Emotional disorders in pairs of patients and their family members during and after ICU stay

INTRODUCTION

Patients and family members undergo different experiences of suffering from emotional disorders during ICU stay and after ICU discharge. The purpose of this study was to compare the incidence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in pairs (patient and respective family member), during stay at an open visit ICU and at 30 and 90-days post-ICU discharge. We hypothesized that there was a positive correlation with the severity of symptoms among pairs and different patterns of suffering over time.

METHODS

A prospective study was conducted in a 22-bed adult general ICU including patients with >48 hours stay. The Hospital Anxiety and Depression Scale (HADS) was completed by the pairs (patients/respective family member). Interviews were made by phone at 30 and 90-days post-ICU discharge using the Impact of Event Scale (IES) and the HADS. Multivariate models were constructed to predict IES score at 30 days for patients and family members.

RESULTS

Four hundred and seventy one family members and 289 patients were interviewed in the ICU forming 184 pairs for analysis. Regarding HADS score, patients presented less symptoms than family members of patients who survived and who deceased at 30 and 90-days (p<0.001). However, family members of patients who deceased scored higher anxiety and depression symptoms (p = 0.048) at 90-days when compared with family members of patients who survived. Patients and family members at 30-days had a similar IES score, but it was higher in family members at 90-days (p = 0.019). For both family members and patients, age and symptoms of anxiety and depression during ICU were the major determinants for PTSD at 30-days.

CONCLUSIONS

Anxiety, depression and PTSD symptoms were higher in family members than in the patients. Furthermore, these symptoms in family members persisted at 3 months, while they decreased in patients.

Physician, patient and family attitudes regarding information on prognosis: a Brazilian survey

BACKGROUND

Communication between physicians and patients is a fundamental aspect of cancer care, yet most physicians' perceptions are often inconsistent with the patients' stated preferences while prognostic information is the most misunderstood.

PATIENTS AND METHODS

Members of the Brazilian Society of Oncology Physicians (n=609) were identified and asked to complete a mailed questionnaire. Outpatients (n=150) and their family members (n=150), oncologists and fellows (n=55) from a public healthcare hospital and a tertiary cancer hospital in Sao Paulo were also personally invited to participate.

RESULTS

A total of 202 physicians, 150 outpatients and 150 family members were participated. The majority of patients (92%) believe they should know about their terminal stage compared with 79.2% of physicians and 74.7% of families (P=0.0003). Cancer patients were most likely to support disclosure of diagnosis and terminality (P=0.001), to consider that this disclosure was not stressful (P<0.0001) and that this knowledge would improve their quality of life (P<0.0001).

CONCLUSIONS

Cancer patients seen in these centers in Southeastern Brazil prefer to know the truth about their poor prognosis more than their physicians and families think. Further studies with larger samples of patients and physicians are necessary to show if our results are representative of all Brazilian situations.

Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios

Introduction

Evidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision.

Methods

We distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision.

Results

Physicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001).

Conclusions

Physicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy.

Conflicts in the ICU: perspectives of administrators and clinicians

PURPOSE

The purpose of this study is to understand conflicts in the ICU setting as experienced by clinicians and administrators and explore methods currently used to resolve such conflicts when there may be discordance between clinicians and families, caregivers or administration.

METHODS

Qualitative case study methodology using semi-structured interviews was used. The sample included community and academic health science centres in 16 hospitals from across the province of Ontario, Canada. A total of 42 participants including hospital administrators and ICU clinicians were interviewed. Participants were sampled purposively to ensure representation.

RESULTS

The most common source of conflict in the ICU is a result of disagreement about the goals of treatment. Such conflicts arise between the ICU and referring teams (inter-team), among members of the ICU team (intra-team), and between the ICU team and patients' family/substitute decision-maker (SDM). Inter- and intra-team conflicts often contribute to conflicts between the ICU team and families. Various themes were identified as contributing factors that may influence conflict resolution practices as well as the various consequences and challenges of conflict situations. Limitations of current conflict resolution policies were revealed as well as suggested strategies to improve practice.

CONCLUSIONS

There is considerable variability in dealing with conflicts in the ICU. Greater attention is needed at a systems level to support a culture aimed at prevention and resolution of conflicts to avoid increased sources of anxiety, stress and burnout.

Family members of critically ill cancer patients: assessing the symptoms of anxiety and depression

OBJECTIVE

To determine prevalence and factors associated with symptoms of anxiety and depression in family members of critically ill cancer patients.

DESIGN

Prospective cohort study.

SETTING

A 23-bed intensive care unit in a tertiary cancer centre.

PATIENTS AND PARTICIPANTS

Three hundred consecutive families of cancer patients with length of stay >72 h in ICU.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

The Hospital Anxiety and Depression Scale questionnaire and critical care family needs inventory were completed by family members. Prevalence of anxiety and depression in family members was 71 and 50.3%, respectively. Regarding the patients' disease, family depression was correlated with presence of metastasis, whereas hematological malignancies correlated with family' anxiety. Anxiety was independently associated with one patient-related factor (prolonged mechanical ventilation) and two family-related factors (catholic religion and gender). Factors associated with symptoms of depression included one patient-related factor (presence of metastasis) and one family-related factor (gender).

CONCLUSIONS

Present findings demonstrated a high prevalence of anxiety and depression in critically ill cancer patients' family members during an intensive care unit stay.

Measuring the satisfaction of intensive care unit patient families in Morocco: a regression tree analysis

OBJECTIVE

Meeting the needs of patients' family members becomes an essential part of responsibilities of intensive care unit physicians. The aim of this study was to evaluate the satisfaction of patients' family members using the Arabic version of the Society of Critical Care Medicine's Family Needs Assessment questionnaire and to assess the predictors of family satisfaction using the classification and regression tree method.

DESIGN

The authors conducted a prospective study.

SETTING

This study was conducted at a 12-bed medical intensive care unit in Morocco.

PATIENTS

Family representatives (n = 194) of consecutive patients with a length of stay >48 hrs were included in the study.

INTERVENTION

Intervention was the Society of Critical Care Medicine's Family Needs Assessment questionnaire.

MEASUREMENTS AND MAIN RESULTS

Demographic data for relatives included age, gender, relationship with patients, education level, and intensive care unit commuting time. Clinical data for patients included age, gender, diagnoses, intensive care unit length of stay, Acute Physiology and Chronic Health Evaluation, MacCabe index, Therapeutic Interventioning Scoring System, and mechanical ventilation. The Arabic version of the Society of Critical Care Medicine's Family Needs Assessment questionnaire was administered between the third and fifth days after admission. Of family representatives, 81% declared being satisfied with information provided by physicians, 27% would like more information about the diagnosis, 30% about prognosis, and 45% about treatment. In univariate analysis, family satisfaction (small Society of Critical Care Medicine's Family Needs Assessment questionnaire score) increased with a lower family education level (p = .005), when the information was given by a senior physician (p = .014), and when the Society of Critical Care Medicine's Family Needs Assessment questionnaire was administered by an investigator (p = .002). Multivariate analysis (classification and regression tree) showed that the education level was the predominant factor contributing to the Society of Critical Care Medicine's Family Needs Assessment questionnaire score. Society of Critical Care Medicine's Family Needs Assessment questionnaire increased (greater satisfaction) with a higher education level. Other factors of great satisfaction included the senior physician providing the information, and Acute Physiology and Chronic Health Evaluation <15.

CONCLUSIONS

Satisfaction of intensive care unit patients' families in a Moroccan sample using the classification and regression tree was dependent on relatives' education level, communication presented by senior caregiver, and low Acute Physiology and Chronic Health Evaluation score. These data underline cultural specificities of the study and suggest that caregivers should develop structured communication programs considering satisfaction predictors.

Families' interactions with physicians in the intensive care unit: the impact on family's satisfaction

PURPOSE

The objective of this study is to correlate the levels of satisfaction of family members, with their perception of the way information was offered and assistance delivered during the patient's stay in the intensive care unit (ICU).

MATERIALS AND METHODS

This is a prospective study conducted in a 13-bed mixed ICU in a tertiary cancer. Family members were enrolled 2 days after admission if the patient remained in the ICU. Questions derived from a previous study assessed the quality of the information and support received (Crit Care Med 1998; 26:1187). To generate the satisfaction criteria, families fulfilled a Portuguese version of the Critical Care Family Needs Inventory.

RESULTS

One hundred sixty-four families were interviewed between May 2002 and May 2003. Insufficient information concerning the consequences of disease was a determinant of dissatisfaction (odds ratio [OR], 3.35; confidence interval [CI], 1.3-8.8), as well as insufficient information given by the ICU doctors (OR, 3.85; CI, 1.2-12.2). Accessibility of doctors was a major determinant of dissatisfaction when considered inadequate (OR, 6.92; CI, 2.3-20.6), and it was associated to a conflict regarding prognosis (P = .017).

CONCLUSION

Family satisfaction and understanding in the ICU may improve if the doctors are more accessible to provide information and the staff strive to better explain the patient's condition.

Family satisfaction in the intensive care unit: cross-cultural adaptation of a questionnaire

PURPOSE

Family needs and expectations are often unmet in the intensive care unit (ICU), leading to dissatisfaction. This study assesses cross-cultural adaptability of an instrument evaluating family satisfaction in the ICU.

MATERIALS AND METHODS

A Canadian instrument on family satisfaction was adapted for German language and central European culture and then validated for feasibility, validity, internal consistency, reliability, and sensitivity.

RESULTS

Content validity of a preliminary translated version was assessed by staff, patients, and next of kin. After adaptation, content and comprehensibility were considered good. The adapted translation was then distributed to 160 family members. The return rate was 71.8%, and 94.4% of questions in returned forms were clearly answered. In comparison with a Visual Analogue Scale, construct validity was good for overall satisfaction with care (Spearman rho = 0.60) and overall satisfaction with decision making (rho = 0.65). Cronbach alpha was .95 for satisfaction with care and .87 for decision-making. Only minor differences on repeated measurements were found for interrater and intrarater reliability. There was no floor or ceiling effect.

CONCLUSIONS

A cross-cultural adaptation of a questionnaire on family satisfaction in the ICU can be feasible, valid, internally consistent, reliable, and sensitive.