Prevalence and Impact of Traumatic Life Events among Black and White Family Members of Intensive Care Unit Patients.

Abstract

Rationale: Lifetime trauma is common and may affect interactions with the healthcare system. Objectives: To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU). Methods: A cross-sectional study was conducted in nine ICUs in one urban and one suburban-rural health system. Participants were Black or White surrogate decision makers for mechanically ventilated patients. Independent variables were the number of lifetime traumatic events measured using the Life Stressor Checklist-Revised (LSC-R) and, secondarily and separately, discrimination-related traumatic stress symptoms. The primary outcome was family-reported conflict with ICU clinicians about treatment decisions. Secondary outcomes were family-reported quality of clinician communication and therapeutic alliance. Results: Among 141 family members (median age, 52.7 yr [interquartile range, 41.9-62.0 yr]; n = 100 women [70.9%]; n = 85 White [60.3%]; n = 56 Black [39.7%]), the median number of lifetime traumatic events was 6.0 (interquartile range, 4.0-9.0). Lifetime trauma was significantly but nonlinearly associated with family-clinician conflict (odds ratio [OR], 1.44 [95% confidence interval (CI), 1.09-1.90] for LSC-R scores of 0-7.5; OR, 0.75 [95% CI, 0.55-1.02] for LSC-R scores of 7.5-16; P = 0.03). Discrimination-related stress symptoms were also associated with conflict (OR, 1.04 [95% CI, 1.003-1.07]; P = 0.03). Interactions between the independent variables and family member race were not significant, suggesting the effects of lifetime trauma and discrimination-related traumatic stress on family-clinician conflict were similar for Black and White caregivers. Conclusions: Lifetime trauma is common among families of critically ill patients and is associated with negative experiences of critical care. Trauma-informed care may reduce family- clinician conflict and improve other measures of family experience.