Family Engagement Using Technology in Adult Intensive Care Units: An Integrative Review

Rationale: Patient- and family-centered care is recognized as a key component of safe and effective care in the Intensive Care Unit (ICU). The COVID-19 pandemic has accelerated the adoption of technologies in health care settings. It is timely to review the current state of science in technology use for family engagement in the ICU. Methods: Following Whittemore and Knafl's methodology, PubMed, CINAHL, Web of Science, and SCOPUS were searched to describe studies that used technology-based strategies to promote family engagement in adult ICUs. We included studies that (1) were conducted in the adult ICU setting, (2) involved family engagement during ICU stay, and (3) involved technology use as a way to engage family members. We excluded studies that were not peer-reviewed journal publications or non-English papers. Study findings were further synthesized based on conceptual elements of patient and family engagement: Collaboration, Respect and Dignity, Activation and Participation, Information Sharing, and Decision Making (Brown et al., 2015, AJRCCM, 191, 358-360). Results: Out of 2702 possible citations, fifteen studies (four observational, five qualitative/mixed methods, and six experimental) were included. The majority of studies (n=14) were conducted between 2015 and 2021. Most studies were at the early stage of development and implementation to investigate participants' perceptions or user experiences with various technologies: web-, tablet-, SMS-, television-based technologies or video-conferencing and robotic telepresence. Those technologies were used to 1) provide information about ICU environment and patient care, 2) augment the decision-making process for caregivers, 3) virtual access to the family decisionmaking conference, or 4) increase family knowledge of interdisciplinary rounds. There was a wide variation in the inclusion of family engagement components among the technologies. At the simplest level, technology was used only for information sharing without tailoring or two-way communication (e.g., tablet-based family education package). In studies addressing most components of family engagement comprehensively, interactive devices enabled tailored information with two-way communication and active family involvement in decision making (e.g., interactive web-based decision aid). Figure 1 displays the conceptual elements of patient and family engagement included by types of technology. Conclusion: The findings of this review may be helpful for future considerations in developing and implementing technology-based strategies to improve family engagement in the ICU. Future research should use more robust methods and develop interventions with close family input. We recommend future studies address conceptual components of family engagement when designing technology-based interventions.