Admission to the Intensive Care Unit is a major stressor for the patient’s family and friends. Dealing with the patient’s family is an essential part of the ICU physician’s practice and recognizing the emotional phases that the family is going through will facilitate communication and decision making.

Every family is different. The way the family will cope with the critical illness of their loved one, to a large extent, depends on the family’s personality. Regardless, most families are going through three distinct phases:

Phase #1: the Shock Phase
The patient is being admitted to the ICU in critical condition. The family is just getting the news. People start showing up in the ICU without a clear understanding of what is going on. Anxiety, confusion and uncertainty are at a heightened level and some people are simply too overwhelmed to comprehend and respond appropriately to the situation. Depending on the patient’s condition, over the next day or so, the family members might be sleeping in the waiting room and keeping a 24 hour vigil in the ICU. The family members will be exhausted, stressed and overwhelmed. This should be considered when trying to make important decisions regarding the patient’s care. The information should be communicated in a concise and easy to understand manner.

Phase #2 the Adjustment Phase
The gravity of the situation will start sinking in. At the same time, the family will start adjusting to the fact that recovery might take time and life is going on. The family members will be trickling in and out. The key family members (husband, wife, parents, children) will, actually, be able to get some rest. The family members will have a better understanding of the disease process and will focus on supporting their loved one. This is a better time to make important medical decisions including withdrawal of care.

Phase #3: the Exhaustion Phase
For some patients recovery takes time and the patient might need to spend days if not weeks in the Intensive Care Unit. This, surely, takes it’s toll on the family as well. The family wants to see signs of improvement and recovery and if this is not happening, a realistic prognosis should be communicated to the family. This also a good time to discuss placement or transfer to an outside facility (nursing home, ventilator facility etc.) if discharging the patient home is not a viable option. Establishing a good relationship and regular updates to the family are very important to facilitate transition to a subacute environment.