App used by ICU patients’ family, clinicians reduces unmet palliative care needs

Key takeaways:

• Care including the ICUconnect app showed more improvement in palliative care needs vs. usual care.
• Anxiety, depression and PTSD symptoms improved moderately/mildly in both the intervention and usual care groups.

WASHINGTON — An app allowing family members of ICU patients to virtually report care needs to ICU clinicians lowered the number of unmet needs, according to research presented at the American Thoracic Society International Conference.

“This trial provides compelling evidence for an easily replicable, intensivist-delivered, ‘primary palliative care’ intervention focused on person-centered outcomes,” Christopher Cox, MD, MPH, MHA, intensivist and palliative medicine specialist at Duke University Medical Center, said in an ATS press release.

In a cluster randomized controlled trial, Cox and colleagues evaluated 111 family member (mean age, 51 years; 83% women; 42% African American)/patient pairs in six adult medical and surgical ICUs who were mechanically ventilated for a minimum of 48 hours to see how the ICUconnect app intervention that is designed for use by family members and ICU clinicians impacted palliative care needs compared with usual care.

According to the study abstract, family members can report needs on the ICUconnect app, and then advice based on these needs is given to ICU attendings through the app.

Researchers mainly assessed the impact of the intervention after 1 week of ICU care compared with usual care by using the Needs at the End-of-Life Screening Tool (NEST), in which a greater score (up to 130) signaled more need.

Further, at 3 months, researchers evaluated changes in symptoms of depression, anxiety and PTSD from day 1 and compared the results between intervention recipients and usual care recipients.

Included patients had comparable characteristics to those of family members, with an equal amount of white and Black patients in this total cohort and divided among the two care types. Researchers randomly assigned 43 ICU physicians to either deliver care with the ICUconnect app (56 recipients) or usual care (55 recipients).

From day 1 to day 3, more improvement in NEST scores were found in the group receiving the app intervention than the group receiving usual care (estimated mean between group difference, –6.7; 95% CI, –12.2 to –1.2; P = .018). This outcome was further observed from Day 1 to day 7, with intervention recipients showing less unmet needs (estimated mean between group difference, –5.4; 95% CI, –10.7 to 0; P = .05), according to the abstract.

When evaluating differences in family member racial groups, more improvement in unmet needs was found with the app intervention vs. usual care in white family members, according to the press release. Both app intervention and usual care yielded improvements in Black family members; however, this improvement was comparable to NEST scores of white individuals prior to intervention.

Assessing changes in symptoms of psychological distress from day 1 to month 3 in the intervention group, researchers found moderate improvement in depression measured by the Patient Health Questionnaire-9 (mean score, 8 to 6) and anxiety measured by the General Anxiety Disorder-7 (mean score, 9.2 to 6.1), whereas only mild improvement was found in terms of PTSD measured by the Post-Traumatic Stress Scale (mean score, 26.2 to 25.4). Patients in the usual care group also showed similar improvement in symptoms of depression (mean score, 7.7 to 6), anxiety (mean score, 8.4 to 5.3) and PTSD (mean score, 24.5 to 23) over this span of time, demonstrating no significant differences based on type of care.

“[This trial] demonstrates that additional studies with larger sample sizes of Black and other marginalized individuals are needed to better understand potential mechanisms of and remedies for these findings including intensivists’ interactions with family members,” Cox said in the release.

Reference:

• ICUconnect app helped clinicians address unmet palliative care needs across course of ICU care. https://www.thoracic.org/about/newsroom/press-releases/conference/resources/palliative-care-and-icu-connect.pdf. Published May 23, 2023. Accessed May 23, 2023.