Interventions using digital technology to promote family engagement in the adult intensive care unit: An integrative review.
Ji Won Shin, JiYeon Choi, Judith Tate
PMID 36525742WHAT IT FOUND
Digital tools in adult ICUs mainly addressed information sharing and family participation, but evidence for reducing family anxiety or improving decisions was mixed.
Most studies tested usability, not outcomes.
Key findings
01Across the included studies, information sharing and activation and participation were the family engagement elements most often addressed, while only four interventions covered all five elements.
02A web-based decision aid reduced surrogate decisional conflict but did not improve clinician-surrogate prognostic concordance; tablet-based family education did not significantly lower stress or anxiety.
03The evidence base was early stage: none of the studies fully described the intervention, and only one reported a planned fidelity monitoring plan without reporting results.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 15 studies, and they varied widely in design, setting, technology, and outcomes. Most studies were at early intervention development or usability testing, not rigorous effectiveness testing. Many studies used investigator-developed survey questions instead of validated measures, making findings hard to compare. None of the studies fully addressed the TIDieR intervention reporting checklist, and only one reported a fidelity monitoring plan without reporting the results. The search was limited to English-language studies in adult ICU inpatient settings, so post-ICU work and non-English research were missed. Few studies assessed family emotional distress or considered age, education, or comfort with technology. Two studies did not pass the quality screening questions.
Declared interests
The work was supported by the Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, the Institute for Innovation in Digital Healthcare, Yonsei University, and the Heather M. Young Postdoctoral Fellowship, Gordon and Betty Moore Foundation. The authors declared no conflict of interest.
The easy way to misread this
Do not read the positive usability reports as proof that digital tools improve ICU family outcomes. Many studies were early-stage usability or perception studies, and between-group effects were inconsistent: only one study found significant anxiety reduction, while a decision aid did not improve prognostic concordance.