Prevalence and Impact of Traumatic Life Events among Black and White Family Members of ICU Patients

Lifetime trauma is common and may affect interactions with the healthcare system. To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU). Cross-sectional study 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. Among 141 family members (median age 52.7 years [IQR 41.9, 62.0]; female n=100, 70.9%; White n=85, 60.3%; Black n=56, 39.7%), the median number of lifetime traumatic events was 6.0 (IQR 4.0, 9.0). Lifetime trauma was significantly but non-linearly associated with family-clinician conflict (OR=1.44, 95% CI: 1.09,1.90 for LSC-R values 0-7.5; OR=0.75, 95% CI: 0.55, 1.02 for LSC-R values 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. 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.