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Canadian Journal of Cardiology

Patient and Family Engagement in Care in the Cardiac Intensive Care Unit

Published:March 31, 2020DOI:https://doi.org/10.1016/j.cjca.2020.03.037

      Abstract

      Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one’s illness, powerless to affect their care, and struggle to comprehend information regarding their loved one’s current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative’s care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.

      Résumé

      L’hospitalisation dans une unité de soins intensifs de cardiologie peut être une expérience stressante pour les patients et leurs familles. Les membres de la famille se sentent souvent dépassés par la gravité de la maladie de leur proche et impuissants à affecter leur soin, et ils ont parfois du mal à comprendre l’information qui leur est transmise sur l’état de santé du patient et sur son plan de traitement. En conséquence, près de la moitié des proches des patients peuvent présenter des symptômes d’ordre psychologique (dépression, anxiété généralisée et trouble de stress post-traumatique) et un syndrome de troubles psychologiques, cognitifs ou émotionnels persistants. Le modèle de participation du patient et de la famille (PPF) est une nouvelle approche visant à donner aux membres de la famille les moyens d’être des partenaires essentiels et actifs dans la prestation des soins et dans la recherche. Dans le contexte des soins au patient, la PPF vise à améliorer l’expérience des soins et à favoriser l’obtention de meilleurs résultats pour les patients et pour leurs proches. De nos jours, les membres de la famille souhaitent de plus en plus participer directement aux soins, être informés des décisions et y prendre part. Les données recueillies tendent de plus en plus à montrer que la participation des membres de la famille aux soins peut améliorer les résultats qui sont importants pour le patient et ses proches après une maladie aiguë et grave. Bien que le rôle de la PPF en matière de soins et de recherche ait été étudié dans le contexte des soins intensifs généraux, les initiatives visant à sensibiliser les cliniciens qui prennent en charge des patients atteints d’une maladie cardiovasculaire aiguë à l’importance de la PPF sont limitées. Nous présentons donc ici les possibilités de PPF dans les unités de soins intensifs de cardiologie, les grandes lignes des données probantes actuelles sur l’importance de la PPF dans les soins aux patients, les obstacles à la PPF et les façons de les surmonter, ainsi que les lacunes des connaissances et les questions qui mériteraient d’être explorées.
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