Improving Partnerships With Family Members of ICU Patients (IMPACT)

Inclusion Criteria for Patients:

1a) > 60 years of age OR

1b) 55 years to 59 years old with one or more of the following diagnoses:

• Chronic obstructive lung disease - 2 of the 4 of: baseline PaCO2 of > 45 torr, cor pulmonale; respiratory failure episode within the preceding year; forced expiratory volume in 1 sec <0.5 L.
• Congestive heart failure - New York Heart Association class IV symptoms and left ventricular ejection fraction < 25%.
• Cirrhosis - confirmed by imaging studies or documentation of esophageal varices and one of three conditions: a) hepatic coma, b) Child's class C liver disease, or c) Child's class B liver disease with gastrointestinal bleeding.
• Cancer - metastatic cancer or stage IV lymphoma.
• End-stage dementia (inability to perform all ADLs, mutism or minimal verbal output secondary to dementia, bed-bound state prior to acute illness) 2) Have a projected duration of ICU dependency of >72 hours from time of final assessment. We define ICU dependency as the need for one or more of the following:
• Mechanical ventilation
• Non-invasive ventilation
• Renal replacement therapy
• Vasopressors or
• Artificial nutrition because of their underlying illness

Exclusion Criteria for Patients:

• Patients who are not expected to remain alive in ICU for 72 hours after initial screening (physician judgment) or for whom life-sustaining treatments are expected to be withdrawn in the subsequent 72 hours (as sufficient time will be required for implementation of the study interventions)
• Uncomplicated elective surgical patients (regardless of age)
• Patients who have received organ transplantation during this hospitalization

Inclusion Criteria for Family Member:

• 18 years of age or older,
• present and expected to visit regularly (minimum about 3 times a week) while the patient is in hospital
• the nominated or legally appointed substitute decision-maker
• able to communicate in English (verbally and in writing).