Background: Communication between families and providers in the intensive care unit (ICU) affects patient and family outcomes, and healthcare utilization. Recent research has tested interventions designed to improve communication quality and outcomes between providers and families of ICU patients. We conducted a systematic review of these studies. Methods: We searched MEDLINE, PsychInfo, Cochrane, and CINAHL from 1995 to July 2010. Included studies reported controlled clinical interventions designed to improve communication between providers and families of ICU patients aged 18 years or older. Investigators abstracted all selected studies to a standardized data collection instrument and completed a quality checklist based on recommendations from the CONSORT investigators. Results: 2841 titles were identified. 180 met criteria for full review and 21 articles of 16 distinct interventions met full inclusion criteria, of which 5 were randomized. Interventions studied included printed information, or structured family conferences with or without additional family support. Conferences aimed to communicate diagnosis and prognosis, elicit patient values, assess family understanding, and clarify goals of treatment. Printed information, palliative care or ethics consultation, or regular, structured communication by the usual ICU team reduced family distress, improved comprehension, and decreased use of intensive treatments. Conclusions: Moderate quality evidence supports printed information and structured communication by the usual ICU team, ethics consultation, or palliative care consultation to improve family emotional outcomes, and reduce ICU lengths of stay and treatment intensity. Evidence that these interventions reduce total costs is inconclusive. A comprehensive research agenda should ensure future study of a full range of patient-centered outcomes.Master of Public Healt
