Fighting a family tragedy: family-centred care in times of the COVID-19 pandemic

Dear Editor,
The COVID-19 pandemic poses unprecedented challenges to intensive care medicine worldwide. Anticipating a mass casualty imposed by COVID-19, intensive care unit (ICU) resources have been increased considerably. Unfortunately, despite great efforts, and even if the best individual medical care can be provided, long-term hospitalisation, disability, and death cannot be prevented with certainty. This situation poses particular emotional challenges for relatives of patients affected by COVID-19.
The post-intensive care syndrome-family (PICS-F) was proposed to refer to acute or chronic psychological effects on the relatives of ICU patients [1]. Uncertainty about the patients’ future, the course of illness, his/her survival, and the unfamiliar environment of an ICU may have an impact on the relatives’ psychological conditions (e.g. anxiety, stress, depression, sleep disturbances). In fact, family members may show a high prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) [2]. In the pre-COVID-19 era, family-centred care concepts were used to address PICS-F (Table 1) [3]. Currently, the burden among relatives of ICU patients may be high, with the current situation posing new challenges for family-centred care.
Dedicated communication is regarded as a key concept of family-centred care and a cornerstone for PICS-F prevention [4]. During the COVID-19 pandemic, face-to-face communication with family members in the ICU is scarce. Thus, building a trusting relationship with the ICU team may be difficult. Visiting restrictions and the enormous workload among ICU staff further limits the ability to provide sufficient communication and information to relatives [5]. Therefore, opportunities for relatives to address needs, to take part in decision-making, and to receive support measures (family care concepts, spiritual support, social worker) are often limited, which may support the development of PICS-F [3]. Additionally, reduced family presence and caregiving at the bedside due to restricted visiting hours may worsen PICS-F [3]. In cases of dying patients, end-of-life conferences and support of the dying can often not be facilitated, which may augment PICS-F [3].
In light of available guidelines for family-centred care in the ICU, it must be noted that several of these concepts may not be feasible during the COVID-19 pandemic (Table 1) [4]. Hence, novel unconventional strategies should be implemented that...


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