Sharon R Lewis|Michael Pritchard|Oliver J Schofield-Robinson|David Evans|Phil Alderson|Andrew F. Smith
Information or education interventions for adult intensive care unit (ICU) patients and their carers
Royal Lancaster Infirmary|Royal Lancaster Infirmary|Royal Lancaster Infirmary|Lancaster University|National Institute for Health and Care Excellence|Royal Lancaster Infirmary
intensive care unit icu admission patients carers experience physical psychological stressors may result psychological conditions including anxiety depression posttraumatic stress disorder ptsd improving communication healthcare professionals patients carers may alleviate disorders communication may include information educational interventions different formats aiming improve knowledge prognosis treatment anticipated challenges icu dischargeto assess effects information education interventions improving outcomes adult icu patients carerswe searched cochrane central register controlled trials central medline embase cinahl psycinfo database inception 10 april 2017 searched clinical trials registries grey literature handsearched reference lists included studies related reviewswe included randomised controlled trials rcts planned include quasircts comparing information education interventions presented participants versus information education interventions comparing information education interventions part complex intervention versus complex intervention without information education included participants adult icu patients carers included relatives nonrelatives including significant representatives patientstwo review authors independently assessed studies inclusion extracted data assessed risk bias applied grade criteria assess certainty evidencewe included eight rcts 1157 patient participants 943 carer participants found quasircts identified seven studies await classification three ongoing studiesthree studies designed intervention targeted patients four carers one patients carers studies included varied information standardised tailored presented several times included verbal written information audio recordings multimedia information interactive information packs five studies reported robust methods randomisation allocation concealment noted high attrition rates five studies feasible blind participants rated studies high risk performance bias unclear risk detection bias outcomes required self reportingwe attempted pool data statistically however always possible due high levels heterogeneity calculated mean differences mds using data reported individual study authors possible narratively synthesised results reported following two comparisonsinformation education intervention versus information education intervention 4 studiesfor patient anxiety pool data three studies 332 participants owing unexplained substantial statistical heterogeneity possible clinical methodological differences studies one study reported less anxiety intervention used md 320 95 confidence interval ci 338 302 two studies reported little difference groups md 040 95 ci 475 395 md 100 95 ci 294 094 similarly patient depression pool data two studies 160 patient participants studies reported less depression information education intervention used md 290 95 ci 400 180 md 127 95 ci 147 107 however uncertain whether information education interventions reduce patient anxiety depression due lowcertainty evidenceit uncertain whether information education interventions improve healthrelated quality life due lowcertainty evidence one study reporting little difference intervention groups md 130 95 ci 499 239 143 patient participants study reported adverse effects knowledge acquisition ptsd severity patient carer satisfactionwe used grade approach downgraded certainty evidence owing study limitations inconsistencies results limited data small studiesinformation education intervention part complex intervention versus complex intervention without information education 4 studiesone study three comparison groups 38 participants reported little difference groups patient anxiety tailored information pack versus control md 009 95 ci 329 347 standardised general icu information versus control md 025 95 ci 434 384 little difference patient depression tailored information pack versus control md 126 95 ci 448 196 standardised general icu information versus control md 147 95 ci 637 343 uncertain whether information education interventions part complex intervention reduce patient anxiety depression due lowcertainty evidenceone study 175 carer participants reported fewer carer participants poor comprehension among given information risk ratio 028 95 ci 015 053 finding uncertain due lowcertainty evidencetwo studies 487 carer participants reported little difference carer satisfaction uncertain whether information education interventions part complex intervention increase carer satisfaction due lowcertainty evidence adverse effects reported one study one participant withdrew deterioration mental health completion anxiety depression questionnaires study authors report whether participant intervention comparison groupwe downgraded certainty evidence owing study limitations limited data small studiesno studies reported severity ptsd healthrelated quality lifewe uncertain effects information education interventions given adult icu patients carers evidence cases low certainty confidence evidence limited ongoing studies may contribute data introduce certainty incorporated future updates review