The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review

Aim: To review the effect of family participation interventions in preventing delirium in Intensive Care Units (ICU). Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the "Synthesis Without Meta-analysis" guidelines. The search was performed using the MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases in April 2024. Eligibility criteria included patients admitted to Intensive Care Units, aged 18 or older exposed to risk factors for delirium, and with family members present; studies about family intervention to prevent delirium, that considered family as a partner in care and included interventions; studies that quantitatively assessed the effect of measures on the incidence and duration of delirium; interventional studies. Two authors independently applied these criteria using the Rayyan (R) application, assessing study quality with Critical Appraisal Skills Programme tools. Results: Fourteen studies were included, involving 33,232 patients. A meta-analysis was not feasible due to the highly heterogeneous results, but we concluded that the family participation interventions for delirium prevention were grouped into single-component and multi-component interventions. The single-component interventions, such as familiar voice messages, flexible visitation, and family presence, showed a favorable response in reducing delirium. The multicomponent interventions suggesting a positive effect included family visitation with professional-guided orientation; familiar voice messages for reorientation, newspaper reading, and nighttime eye patch use; sensory stimulation program; the ABCDEF bundle; the DyDel program; family education, emotional support, orientation training, cognitive stimulation, and ICU life care participation. Conclusions: Several family participation interventions, both single-component and multicomponent, have shown positive effects on outcomes in preventing delirium in ICU patients, particularly in reducing its incidence and duration. Implications for Clinical Practice: Identifying the family participation interventions that can prevent delirium allows the development of measures to minimize its occurrence in ICU.