Mechanism of a Flexible ICU Visiting Policy for Anxiety Symptoms Among Family Members in Brazil: A Path Mediation Analysis in a Cluster-Randomized Clinical Trial.

Autor:	Rosa RG; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Pellegrini JAS; Department of Critical Care, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil., Moraes RB; Department of Critical Care, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.; Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil., Prieb RGG; Department of Critical Care, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil., Sganzerla D; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Schneider D; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Robinson CC; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Kochhann R; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., da Silva DB; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Amaral A; Department of Critical Care, DF-Star Rede D'Or na Rede D'Or São Luiz, Brasília, Distrito Federal, Brazil., Prestes RM; Department of Critical Care, Hospital Universitário da Universidade Federal do Piauí, Teresina, Piauí, Brazil., Medeiros GS; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Falavigna M; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil., Teixeira C; Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil.; Department of Critical Care, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2021 Sep 01; Vol. 49 (9), pp. 1504-1512.
DOI:	10.1097/CCM.0000000000005037
Abstrakt:	Objectives: To investigate whether the effect of a flexible ICU visiting policy that includes flexible visitation plus visitor education on anxiety symptoms of family members is mediated by satisfaction and involvement in patient care. Design: We embedded a multivariable path mediation analysis within a cluster-randomized crossover trial as a secondary analysis of The ICU Visits Study (ClinicalTrials.gov number: NCT02932358). Setting: Thirty-six medical-surgical ICUs in Brazil. Patients: Closest relatives of adult ICU patients. Interventions: Flexible visitation (12 hr/d) supported by family education or usual restricted visitation (median, 1.5 hr/d). Measurements and Main Results: Overall, 863 family members were assessed (mean age, 44.7 yr; women, 70.1%). Compared with the restricted visitation (n = 436), flexible visitation (n = 427) resulted in better mean anxiety scores (6.1 vs 7.8; mean difference, -1.78 [95% CI, -2.31 to -1.22]), as well as higher standardized scores of satisfaction (67% [95% CI, 55-79]) and involvement in patient care (77% [95% CI, 64-89]). The mediated effect of flexible visitation on mean anxiety scores through each incremental sd of satisfaction and involvement in patient care were -0.47 (95% CI, -0.68 to -0.24) and 0.29 (95% CI, 0.04-0.54), respectively. Upon exploratory analyses, emotional support, helping the ICU staff to understand patient needs, helping the patient to interpret ICU staff instructions, and patient reorientation were the domains of involvement in patient care associated with increased anxiety. Conclusions: A flexible ICU visiting policy reduces anxiety symptoms among family members and appears to work by increasing satisfaction. However, increased participation in some activities of patient care as a result of flexible visitation was associated with higher severity of anxiety symptoms. Competing Interests: Drs. Rosa, Sganzerla, Schneider, Robinson, Kochhann, da Silva, Medeiros, and Falavigna report grants from Brazilian Ministry of Health during the conduct of study. Drs. Rosa’s, Sganzerla’s, and Medeiros’s institutions received funding from Brazilian Ministry of Health. Dr. da Silva received funding from Brazilian Ministry of Health. Dr. Amaral’s institution received funding from Hospital Moinhos de Vento. Drs. Amaral, Prestes, and Medeiros disclosed government work. Dr. Prestes’ institution received funding from Hospital Universitário da Universidade Federal do Piauí. Dr. Falavigna received funding from Roche, Novartis, Abbvie, Boehringer Ingelheim, Ultragenix, PTC Therapeutics, and Sanofi Genzime, and he received support for article research from the Canadian Institutes of Health Research. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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