# Evaluating effectiveness of a communication facilitator to reduce distress and improve goal concordant care for critically ill patients and their families

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2020 · $659,737

## Abstract

PROJECT SUMMARY
The impact of critical illness is increasing due to our aging population as well as advances in effectiveness and
availability of critical care. Critically ill patients and their families suffer a high burden of symptoms of
depression, anxiety, and post-traumatic stress due, in part, to fragmented medical care that is often poorly
aligned with their goals. Fragmented care includes numerous transitions for patients and families across
clinicians and across settings, starting in the ICU and extending to acute care, skilled nursing facilities, or
home. As illness progresses, patients and families struggle to navigate the spectrum of goals of care, to match
their values and goals with treatments, to communicate their goals to their clinicians, and to make difficult
medical decisions without letting unmet emotional needs interfere. Poor communication exacerbated by these
transitions compounds an already stressful experience, causing distress to patients and their families. Taken
together, these issues lead to ineffective communication during and after the ICU which can often result in high
intensity “default” care that may be unwanted. Using a randomized trial, this application proposes to evaluate
an innovative model of care in which ICU nurse facilitators support, model, and teach communication
strategies that enable patients and families to secure care in line with their goals over an illness trajectory,
beginning in the ICU and continuing into the community. Facilitators will use communication skills, attachment
theory, and mediation to improve: 1) patients' and families' self-efficacy to communicate with clinicians within
and across settings; 2) patients' and families' outcome expectation that communication with clinicians can
improve their care; and 3) patients' and families' behavioral capability through skill building to resolve barriers
to effective communication and mediate conflict. Facilitators will work with seriously ill patients (n=376) and
their families (n=564) beginning with a critical care unit stay and following them over the course of 3 months.
The intervention's effectiveness will be measured with patient- and family-centered outcomes including
symptoms of depression, anxiety, and post-traumatic stress, as well as quality of life and assessments of goal-
concordant care, at 1, 3, and 6 months post-randomization. The primary outcome will be family members'
burden of symptoms of depression over the 6 months. We will also evaluate whether the intervention improves
the value of healthcare by reducing healthcare costs while improving patient and family outcomes. Finally, we
will use qualitative methods to explore implementation factors (intervention, settings, individuals, processes)
associated with improved implementation outcomes (acceptability, fidelity, penetration) to inform dissemination
of this type of intervention to support patients and their families. This application will address key knowledge
gaps while eva...

## Key facts

- **NIH application ID:** 9949798
- **Project number:** 5R01NR018161-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** J Randall Curtis
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $659,737
- **Award type:** 5
- **Project period:** 2018-09-27 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9949798

## Citation

> US National Institutes of Health, RePORTER application 9949798, Evaluating effectiveness of a communication facilitator to reduce distress and improve goal concordant care for critically ill patients and their families (5R01NR018161-03). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/9949798. Licensed CC0.

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