Mobile Application–Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial

Cox, CE; Ashana, DC; Riley, IL; Olsen, MK; Casarett, D; Haines, KL; O'Keefe, YA; Al-Hegelan, M; Harrison, RW; Naglee, C; Katz, JN; Yang, H; Pratt, EH; Gu, J; Dempsey, K; Docherty, SL; Johnson, KS

doi:10.1001/jamanetworkopen.2023.49666

ICU sedation, delirium & recovery

Mobile Application–Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial

JAMA Netw OpenPublished 2 Jan 2024Cluster randomised controlled trial

Primary resultResultEstimated mean difference −6.6 points 95% CI −11.9 to −1.3

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Authors' conclusion

In this study of ICU patients and family members, a primary palliative care intervention using a mobile application reduced unmet palliative care needs compared with usual care without an effect on psychological distress symptoms at 3 months; there was a greater intervention effect among White family members compared with Black family members.

Study context

Population: Mechanically ventilated patients, their family members and attending physicians in 6 adult medical and surgical intensive care unit (ICUs), North Carolina, 2019–2022
Participants: 111 patient-family dyads

Comparison: Mobile application primary palliative care intervention vs usual care
Interventionn = 55
Controln = 56reference
Primary endpoint: Change in family-reported NEST score (range 0-130, higher = greater need)
Follow-up: Between study days 1 and 3

Methodological detailsphysician-level randomization, multicentre

Physician-level randomization
Multicentre

Primary result

As reported in the abstract

day 3

Estimated mean difference

−6.6 points

95% CI −11.9 to −1.3

P = 0.01

Intervention vs Control

estimated mean difference −6.6 points (95% CI −11.9 to −1.3); P = 0.01

Secondary outcomes

Outcome	← Lower with intervention ←→ Higher with intervention →	Estimated mean difference (points) (95% CI)	P value
Change in NEST score from baseline · day 7	−15−10−505	−5.4 (−10.7 to 0.0)	P = 0.05
	−15−10−505Difference, points (linear scale)

Change in NEST score (subgroup: White family members) · day 3

	← Lower ←→ Higher →	Estimated mean difference (points) (95% CI)	P value
White family membersIntervention effect within subgroup	−20−10010	−12.5 (−18.9 to −6.1)	P < 0.001
	−20−10010Difference, points (linear scale)

Change in NEST score (subgroup: Black family members) · day 3

	← Lower ←→ Higher →	Estimated mean difference (points) (95% CI)	P value
Black family membersIntervention effect within subgroup	−10−50510	−0.3 (−9.3 to 8.8)	P = 0.96
	−10−50510Difference, points (linear scale)

Change in NEST score (subgroup: White family members) · day 7

	← Lower ←→ Higher →	Estimated mean difference (points) (95% CI)	P value
White family membersIntervention effect within subgroup	−20−10010	−9.5 (−16.1 to −3.0)	P = 0.005
	−20−10010Difference, points (linear scale)

Change in NEST score (subgroup: Black family members) · day 7

	← Lower ←→ Higher →	Estimated mean difference (95% CI)	P value
Black family membersIntervention effect within subgroup	−15−10−50510	−1.4 (−10.7 to 7.8)	P = 0.76
	−15−10−50510Difference (linear scale)

Psychological distress symptoms · 3 months

No treatment group differences

Original publication

Mobile Application–Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial. JAMA Netw Open. Published 2 January 2024. doi:10.1001/jamanetworkopen.2023.49666

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