Highlights
– Nurse-led, in-person, structured and tailored family communication in the ICU modestly improves communication quality (SMD = 0.26) and is associated with shorter hospital length of stay (MD ≈ -3.87 days).
– Interventions vary by implementer: bedside nurses focus on information delivery and assessment; internal research nurses coordinate meetings and clarify needs; external research nurses provide structured emotional and transitional support.
– No convincing effect was found on family psychological distress, satisfaction, ICU LOS, or mortality; heterogeneity in intensity, implementer roles, and reporting limits generalizability.
Background
Family members play a central role in caring for critically ill adults in the intensive care unit (ICU). Effective communication between clinicians and families supports shared decision-making, reduces uncertainty, and can mitigate poor psychological outcomes among relatives. Nurses are uniquely positioned at the interface of bedside care and family contact: they have frequent, longitudinal contacts, understand patient trajectories, and can coordinate multidisciplinary communication. Despite this, the optimal design, intensity, and staffing model for nurse-led family communication interventions in the ICU remain uncertain.
Study design and methods
Li et al. conducted a systematic review and meta-analysis (search period January 1995 to July 2025) to determine the characteristics and effectiveness of nurse-led family communication interventions in adult ICUs. Data sources included PubMed, Web of Science, PsychInfo, CINAHL, Embase, the Cochrane Library, and citation chasing. Randomized controlled trials (RCTs) and quasi-experimental studies were eligible.
Key methodological features of the review:
- Study types included: seven RCTs and seven quasi-experimental studies.
- Intervention description: summarized using the Template for Intervention Description and Replication (TIDieR) checklist.
- Quality appraisal: Cochrane risk-of-bias tool and Joanna Briggs Institute Critical Appraisal Tools applied by two independent reviewers.
- Reporting: synthesis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.
Key findings
Intervention characteristics and nursing roles
Across the 14 included studies, the most common model of nurse-led family communication was an in-person, structured intervention adapted dynamically during the patient’s ICU stay. Interventions ranged from single bedside conversations to repeated structured family meetings and transitional support at discharge.
The review identified five core nursing roles embodied within the interventions:
- Information delivery and clarification — providing updates on condition, treatments, and prognosis.
- Emotional support — active listening, validation, and stress-reduction strategies.
- Family assessment — structured appraisal of informational, emotional, and practical needs.
- Family meeting facilitation — arranging, coordinating, or leading multidisciplinary conferences.
- Transitional support — preparing families for discharge, goals-of-care transitions, or follow-up.
Implementation models diverged by who performed these roles:
- Bedside ICU nurses primarily delivered information and performed multidimensional family assessments during routine care.
- Internal research nurses (nurses embedded within the ICU team for the study) tended to clarify information, conduct structured needs assessments, and coordinate family meetings.
- External research nurses (nurses not normally part of the ICU clinical team) focused on structured emotional support, family meeting facilitation, and transitional care tasks.
Effectiveness — primary outcomes
Communication quality: Pooled analyses suggested a small but statistically detectable improvement in communication quality with nurse-led interventions (standardized mean difference [SMD] = 0.26). This magnitude corresponds to a small effect size, indicating improved perceived clarity, timeliness, or helpfulness of communication from the family perspective.
Hospital length of stay (LOS): Across studies reporting hospital LOS, nurse-led interventions were associated with a shorter hospital stay (mean difference [MD] = -3.87 days). This is a clinically meaningful reduction if replicated and attributable to improved decision-making or care transitions driven by better communication.
Effectiveness — secondary outcomes
Psychological distress: Interventions appeared to have limited or inconsistent effects on family psychological outcomes (e.g., symptoms of anxiety, depression, or post-traumatic stress). Most studies did not demonstrate clinically meaningful reductions in these measures.
Satisfaction: Measures of family satisfaction with care showed mixed results — some single studies reported improvements, but pooled analyses did not show consistent, robust benefits.
ICU length of stay and mortality: The review identified no clear effects on ICU LOS or in-hospital mortality.
Resource use and process outcomes: Nurse-led communication interventions tended to increase the frequency and duration of family meetings and, in some studies, were associated with lower overall costs — likely related to shorter hospital LOS and improved coordination; however, reporting on cost was limited and heterogeneous.
Safety and unintended consequences
The included studies did not report safety signals attributable to nurse-led communication interventions. Potential unintended consequences — such as increased staff time burden or compassion fatigue among nurses — were highlighted as plausible but not consistently measured across studies.
Heterogeneity and methodological quality
Substantial heterogeneity existed across interventions in terms of intensity (single encounter vs serial contacts), timing (early vs later in ICU stay), mode (bedside vs scheduled family meetings), and who delivered the intervention (bedside vs embedded vs external nurses). This heterogeneity, coupled with variability in outcome measures and study designs, limits the ability to draw definitive causal inferences or to prescribe a single optimal model.
Expert commentary and interpretation
Clinical interpretation
The review suggests that nurse-led family communication in the ICU can improve the perceived quality of communication and may shorten overall hospital stay. Given nurses’ continuous bedside presence and established role as communicators and care coordinators, strategically empowering nurses to provide structured family communication makes conceptual and operational sense.
Why psychological outcomes may not change
Psychological distress among family members (often grouped under PICS-F — post-intensive care syndrome-family) is complex and influenced by preexisting vulnerability, the severity and trajectory of the patient’s illness, and socioeconomic factors. Single or moderate-dose communication interventions, even if high-quality, may be insufficient to change longer-term psychological trajectories without integrated mental health supports, continuity after discharge, or targeted interventions for high-risk relatives.
Who should deliver the intervention?
Findings emphasize distinct advantages to different implementer models: bedside nurses are ideal for timely information delivery and ongoing assessment; embedded/internal research nurses can provide structured assessments and coordinate multi-professional meetings; external nurses may be useful where bedside nursing workload precludes expanded communication roles. An optimal model may thus combine role-specific responsibilities and training.
Implementation considerations
Successful translation will require clearer specification of intervention dose, training competencies (e.g., communication skills, family assessment), and workflow integration. Use of structured tools (TIDieR-style descriptions, checklists, communication scripts) and implementation frameworks (e.g., Plan-Do-Study-Act cycles, CFIR) can help standardize delivery and allow pragmatic adaptation.
Policy and staffing implications
Institutions should consider: formalizing communication responsibilities within nursing job descriptions, providing dedicated time or staffing for family communication, training bedside nurses in structured communication techniques, or creating a specialized communication facilitator role (nurse navigator/liaison) where feasible. These investments may yield benefits in communication quality and hospital throughput.
Limitations of the evidence
– Considerable heterogeneity in intervention content, intensity, timing, and implementers across studies limits pooled inference and external validity.
– Outcome measures were inconsistent; few studies used harmonized, validated instruments for communication quality or long-term family psychological outcomes.
– Potential for performance and detection bias given the difficulty of blinding participants and staff to communication interventions.
– Limited economic evaluations and sparse reporting on staff workload, sustainability, and potential harms (e.g., burnout).
Practical recommendations for clinicians and administrators
- Prioritize clear, structured communication with families early and repeatedly during the ICU stay, using documented checkpoints (e.g., admission, clinical milestones, family meetings, and transition).
- Train bedside nurses in brief structured communication techniques (e.g., information framing, needs assessment, and emotional support) and provide protected time where possible.
- Consider creating or piloting a dedicated communication facilitator or liaison nursing role if resources permit; define role responsibilities clearly and integrate with multidisciplinary decision-making.
- Measure outcomes pragmatically: adopt validated instruments for communication quality, track hospital and ICU LOS, and monitor family psychological distress over time to identify who benefits most.
- Use implementation frameworks and TIDieR-style reporting when piloting interventions to facilitate replication and adaptation.
Conclusions
Nurse-led family communication interventions in the ICU show modest improvements in communication quality and may reduce hospital length of stay, but evidence for effects on psychological distress, satisfaction, ICU LOS, or mortality is limited. Heterogeneity in intervention design and delivery constrains strong recommendations about an optimal model. Forward progress requires standardized intervention reporting, clearer specification of dose and implementer roles, rigorous measurement of both short- and long-term family outcomes, and pragmatic implementation studies that evaluate sustainability, staff burden, and cost-effectiveness.
Funding and clinicaltrials.gov
Funding: Funding sources were not specified in the summary provided here. Please consult the original article for detailed disclosures.
ClinicalTrials.gov: Not applicable as a single randomized controlled trial; individual included trials may have registry entries — see the primary report for study-level identifiers.
References
Li Z, Lu F, Abshire Saylor M, Wu J, Reynolds NR, Wang J, Hwang H, Wang H, Wenzel J. Characteristics and Effectiveness of Nurse-Led Family Communication Interventions in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2025 Nov 14. doi: 10.1097/CCM.0000000000006952 IF: 6.0 Q1 . Epub ahead of print. PMID: 41236180 IF: 6.0 Q1 .
