Technology Interventions to Promote Family Engagement in the Adult Intensive Care Unit: An Integrative Review (Preprint)

Patient and family engagement is recognized as a key component of safe and effective patient-centered care in the intensive care unit (ICU). The coronavirus disease 2019 pandemic has accelerated the adoption of technologies in healthcare settings to enable family engagement from a distance. It is important to review the current state of science regarding the use of technology for family engagement in the ICU. This integrative review aimed to identify and evaluate studies that used technology to promote family engagement in adult ICUs and synthesize the study findings based on the conceptual elements of patient and family engagement in ICUs. Following Whittemore and Knafl's methodology, PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus were searched by three authors to identify studies that have used technology-based strategies to promote family engagement in adult ICUs. We included studies that were conducted in the adult ICU setting; involved family engagement during ICU stay; and involved technology use as a way to engage family members. We excluded studies that were not peer-reviewed or in English. Study findings were assessed using Brown’s et al. (2015) conceptual elements of patient and family engagement: collaboration, respect and dignity, activation and participation, information sharing, and decision making. Of 2702 citations, 15 studies (three quantitative observational, five qualitative mixed-methods, and seven experimental) were included. Most of the studies (n=14) were conducted between 2015 and 2021 and were at an early stage of development and implementation to investigate the participants' perceptions or user experiences with various technologies, such as web-, tablet-, SMS-, or television-based technologies; video-conferencing; and robotic telepresence. These technologies were used to provide information about the ICU environment and patient care; augment the decision-making process for caregivers; provide virtual access to family decision-making conferences; or increase family knowledge of interdisciplinary rounds. Among the technologies, there was wide variation in the inclusion of the family engagement components. At a basic level, technology was used only for information sharing without tailoring or two-way communication (e.g., a tablet-based family education package). In studies addressing the components of family engagement more comprehensively, interactive devices enabled tailored information with two-way communication and active family involvement in decision-making processes (e.g., interactive web-based decision aid). Figure 1 displays the conceptual elements of patient and family engagement according to the types of technology. These findings may be helpful for the future development and implementation of technology-based strategies to improve family engagement in the ICU. Future research should use more robust methods and develop interventions with close family’s input. For future studies involving technology-based interventions, we recommend using conceptual components of family engagement when judging the quality of the technology.