Engaging Family Caregivers with Structured Communication for Safe Care Transitions

Abstract

Objectives. To summarize recent relevant literature on patient safety practices (PSPs) focused on engaging family caregivers with structured communication during care transitions and assess the effectiveness of these PSPs to improve safety during care transitions. This review provides information for clinicians, health system leaders, and policymakers to better inform approaches to engaging family caregivers with structured communication to improve safety during care transitions. Methods. We followed rapid review processes provided by the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We searched PubMed, Embase, and the Cochrane Library for eligible studies published in 2010 through June 30, 2023, supplemented by targeted gray literature searches and review of reference lists in relevant systematic reviews. We used prespecified inclusion and exclusion criteria to assess relevant studies conducted in the United States that analyzed the effect of structured communication on care transitions with family caregivers. Prespecified clinical and patient-related outcomes included healthcare utilization, symptom exacerbation, quality of life, satisfaction, and unintended harms, among others. Findings. We identified 323 unique citations for possible inclusion; we assessed 86 full-text articles for inclusion. We included nine studies on effectiveness (2 randomized controlled trials, 6 pre-post studies, and 1 single-arm study) which assessed PSPs focused on discharge to home, transfers from intensive care units, and transitions from residential care. In residential treatment facility discharges, we found PSPs improved caregiver satisfaction (low strength of evidence [SOE]). We found insufficient evidence of other PSPs on any other included outcomes. Five studies detailed implementation facilitators, and two studies noted specific barriers to PSP implementation. While no studies specifically reported the resources required to implement PSPs, based on study descriptions, we identified four prominent resource considerations: (1) allocated time for pre-implementation intervention development and staff training; (2) designated time to deliver PSPs to family caregivers; (3) technology-based resources; (4) staff-expertise/addition training for designated roles. None of the studies reported rates of unintended harms. Conclusions. Clear communication with patients and caregivers during care transitions is important, but there is little evidence on the effectiveness of these PSPs. Included studies showed improvement in caregiver satisfaction, but more high-quality research is needed to assess the effectiveness of PSPs and unintended harms.