Family-related Outcomes Research Articles

Summarising Quantitative Outcomes in Parental Mental Illness Research.

A quarter of all children grow up in a family where a parent experiences a mental illness (FaPMI). Research activity in this area is growing rapidly and it is now critical to better understand the extant knowledge in the field. This scoping review of quantitative FaPMI literature parallels a qualitative literature review and a series of Delphi studies with key stakeholders (e.g. lived experience and clinicians), that is part of a larger program of research to achieve consensus regarding the direction of FaPMI research; including making recommendations about outcomes and measures. The programme of research aims to promote and facilitate greater comparison and learning across studies and settings. Initially this scoping review summarises the quality and focus (e.g. country and sampling) of 50 quantitative studies from 2000 to 2023 and then classifies studies according to outcomes for parents, children and families. Six to eleven years were the most common child sample group and girls were slightly underrepresented (49/51) and parents were 88% mothers. Analogous parent and child outcomes were; mental illness/psychopathology, wellbeing, mental health literacy, trauma and stressful experiences, coping, help seeking/service need, within family relationships and supports, outside family relationships and supports. Additional outcomes for parents were; parenting skills, parent competence and parenting stress and for children in relation to their; cognitive functioning and caregiving. The family related outcomes were the within and outside family relationships and supports. Since 2000 there have been 136 different survey instruments employed with approximately 80% used in only one study. This suggests that the broader goals of the program of research are warranted as there is a need for less heterogeneity in measures used. Suggested areas for future research include a sampling focus on fathers, economic evaluations of programs, parent mental health literacy, trauma, genetics and integrating well-being concepts into research designs. Child research should focus on mental health literacy, the level and impact of caring responsibilities, assessing past trauma and the roles of close family and external supports.

Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis.

The family is the primary caregiver for most patients with schizophrenia, and their roles are essential in patients' illness trajectories and outcomes. Due to this, various family interventions for schizophrenia have been developed and applied to the relatives who take care of their family members with schizophrenia. This study examined the effectiveness of existing family interventions for schizophrenia in achieving their target outcomes at both the family and patient levels by utilizing a systematic review and meta-analysis. Combinations of terms were used to search for relevant studies from the databases. Thirty-seven randomized controlled trials that met the inclusion criteria were included in the analysis. Based on the pooled result of the included studies, the programmes significantly improved the targeted outcomes with large effect size. The programmes' impacts on family-related outcomes were higher than those on patients. Among the targeted outcomes, patients' treatment satisfaction and adherence and family caregivers' mental health were the most remarkable outcomes that had improved from the included programmes. Conversely, outcomes related to family relationships, caregiving experiences, perceived social support of family caregivers, and patients' medication use did not see significant improvements. The programmes delivered to individual family units and only to the family caregivers were more effective than those delivered to groups of caregivers and caregivers and patients together, respectively. Programme-focused interventions were more effective than emotion-focused ones. Based on these findings, an in-home visiting nurse programme or advanced technology is suggested when applying family interventions for schizophrenia in practice.

A tornado in the family: fetal alcohol spectrum disorder and aggression during childhood and adolescence: a scoping review.

Aggression exhibited by children and youth with Fetal Alcohol Spectrum Disorder (FASD) toward family members is a major cause of stress and anxiety for caregivers, but relatively little attention has been directed toward designing interventions specific to this phenomenon. In light of the serious negative impact of this issue for families, a scoping review was undertaken to summarize the evidence available on psychosocial interventions that may mitigate the frequency and severity of aggression exhibited by children and youth with FASD toward family members. This review was designed using PRISMA-SCR and JBI scoping review guidelines. Three databases were searched in August 2021: EMBASE, PsychINFO, and Medline. A total of 1,061 studies were imported for screening with only five studies meeting full eligibility criteria. None of the interventions were aimed at specifically targeting aggression and instead reported on broader constructs of externalizing behaviors such as hyperactivity. The interventions were limited to school-aged children. Studies reported primarily on child outcomes while only one reported on family related outcomes. Following from this review of the literature, we argue that aggression is a related but separate construct from other behavioral problems most frequently targeted by parenting interventions. Given the often dire consequence of aggression displayed by children and youth with FASD and the limited number of studies, there is an urgent need for research on how to support families to manage this specific type of behavior in this population.

Parents' attending status and alcohol consumption on family cohesion and satisfaction at art festivals

PurposeThis study explores the effects of parents' attending status and alcohol consumption (scenario based) on their feelings of happiness, relaxation, family cohesion and family satisfaction.Design/methodology/approachThis study uses a 2 (attending status: with a child or without a child) X 3 (alcohol consumption: water, a cup of beer or four cups of beers) between-subjects experimental design on an art festival and employs relational cohesion theory while spillover theory.FindingsThe results reveal (1) significant differences between parents' attending status on happiness and relaxation; (2) significant differences between alcohol consumption on happiness, family cohesion, and family satisfaction and (3) happiness significantly mediates the effect of parents' alcohol consumption on family cohesion and family satisfaction.Practical implicationsAttending art festivals provides families with a chance to consolidate family relationships. Art festival planners could promote the festival through enhancing participants' family cohesion and satisfaction through potential family leisure activities.Originality/valueEvents are an emerging topic in the hospitality and tourism discipline in recent years. Social impacts, especially family-related outcomes, on art festivals are barely examined. Additionally, while alcohol consumption is common in festivals, the influence of alcohol consumption on the attendees' emotions and behaviors is under-researched.

The Impact of Dental Care Programs on Individuals and Their Families: A Scoping Review.

Despite significant global improvements in oral health, inequities persist. Targeted dental care programs are perceived as a viable approach to both improving oral health and to address inequities. However, the impacts of dental care programs on individual and family oral health outcomes remain unclear. The purpose of this scoping review is to map the evidence on impacts of existing dental programs, specifically on individual and family level outcomes. We systematically searched four scientific databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts for studies published in the English language between December 1999 and November 2021. Search terms were kept broad to capture a range of programs. Four reviewers (AG, VD, AE, and KKP) independently screened the abstracts and reviewed full-text articles and extracted the data. Cohen's kappa inter-rater reliability score was 0.875, indicating excellent agreement between the reviewers. Data were summarized according to the PRISMA statement. The search yielded 65,887 studies, of which 76 were included in the data synthesis. All but one study assessed various individual-level outcomes (n = 75) and only five investigated family outcomes. The most common program interventions are diagnostic and preventive (n = 35, 46%) care, targeted children (n = 42, 55%), and delivered in school-based settings (n = 28, 37%). The majority of studies (n = 43, 57%) reported a significant improvement in one or more of their reported outcomes; the most assessed outcome was change in dental decay (n = 35). Dental care programs demonstrated effectiveness in addressing individual oral health outcomes. However, evidence to show the impact on family-related outcomes remains limited and requires attention in future research.

The effect of end-of-life decision-making tools on patient and family-related outcomes of care among ethnocultural minorities: A systematic review.

End-of-life decision-making tools are used to establish a shared understanding among patients, families and healthcare providers about medical treatment and goals of care. This systematic review aimed to understand the availability and effect of end-of-life decision-making tools on: (i) goals of care and advance care planning; (ii) patient and/or family satisfaction and well-being; and (iii) healthcare utilization among racial/ethnic, cultural, and religious minorities. A search was conducted in four electronic databases (inception to June 2021). Articles were screened for eligibility using pre-specified criteria. We focused on adult patients (aged ≥18 years) and included primary research articles that used quantitative, qualitative, and mixed-methods designs. Complementary quality assessment tools were used to generate quality scores for individual studies. Extracted data were synthesized by outcome measure for each type of tool, and an overall description of findings showed the range of effects. Among 14,316 retrieved articles, 37 articles were eligible. We found that advance care planning programs (eleven studies), healthcare provider-led interventions (four studies), and linguistically-tailored decision aids (three studies) increased the proportion of patients documenting advance care plans. Educational tools (three studies) strongly reduced patient preferences for life-prolonging care. Palliative care consultations (three studies) were strongly associated with do-not-resuscitate orders. Advance care planning programs (three studies) significantly influenced the quality of patient-clinician communication and healthcare provider-led interventions (two studies) significantly influenced perceived patient quality of life. This review identified several end-of-life decision-making tools with impact on patient and family-related outcomes of care among ethnocultural minorities. Advance care planning programs, healthcare provider-led interventions and decision aids increased documentation of end-of-life care plans and do-not-resuscitate orders, and educational tools reduced preferences for life-prolonging care. Further research is needed to investigate the effect of tools on healthcare utilization, and with specific patient population subgroups across different illness trajectories and healthcare settings.

Longitudinal Psychological Family Studies in Austria: A Scoping Review

Longitudinal psychological research on family outcomes provides crucial information about families in a changing society, but an evidence synthesis for Austria is currently lacking. Therefore, we aim to summarize psychological longitudinal research on family-related outcomes in Austria using a scoping review approach. Adhering to PRISMA guidelines, we searched five scientific databases (PsycInfo, PSYNDEX, Pubmed, Scopus, and Web of Science) and conducted manual searches to identify additional grey literature. Ten sources reporting on six data collection efforts between 1991 and 2015 were identified. Most samples consisted of heterosexual nuclear families, while research on more diverse family types is needed. Methods were primarily quantitative with conventional designs, but noteworthy exceptions exist. Comprehensive longitudinal data collection efforts across child development are lacking for the new millennium. State-of-the-art research implementing a triangulation of methods, designs, and perspectives that incorporate diverse family types is needed to draw accurate conclusions about the changing family landscape in Austria.

Parents in couple therapy: An intervention targeting marital and coparenting relationships.

This article describes the treatment framework and core therapeutic principles of the integrative brief systemic intervention (IBSI), a manualized six‐session intervention intended for parents seeking couple therapy. IBSI aims to work on the couple's presenting problem, considering its specific impact in the marital and coparenting domains. The basic premise of IBSI is to consider that, when working with couples who have children, therapeutic work on their coparenting alliance may be used as a lever, as both parents may be particularly motivated to improve their relationship for their children's benefit. Increasing the coparenting alliance may then facilitate work on deeper conflicts within the marital relationship. The core therapeutic principles of IBSI are: (1) joining with the couple as romantic partners and a coparenting team from the start of the therapeutic process; (2) supporting the parents in increasing their awareness regarding their children's behavior and emotional experiences when facing their parents’ conflicts; and (3) working on the spill‐ and cross‐over effects between marital and coparenting relationships (i.e., exploring how conflict or positivity spills over from one relationship to the other or crosses over from one partner to the other). Therapeutic work following these main therapeutic principles is expected to improve the quality of both relationships. A clinical case is provided to illustrate the core therapeutic principles of IBSI.

Introduction to the special collection on family changes and inequality in East Asia.

BACKGROUNDEast Asian societies have experienced rapid social changes, among which the extraordinary expansion of higher education for both women and men, rising economic inequality, and increasing labor market uncertainty should be particularly relevant to family changes. At the same time, gender inequality and traditional gender norms still prevail and shape family life in the region. The eight articles in this special collection share the common interest of how families in East Asia have evolved against a backdrop of growing economic inequality and persistent gender inequality – among other key forces affecting family life – across a variety of family-related outcomes: from singlehood, marriage intentions, and dating, through fertility, the time use of adolescents and parents with young children, and women’s careers, to intergenerational coresidence and the life satisfaction of older parents.RESULTSOur eight studies look at connected but distinctive outcomes related to family life, and collectively demonstrate the relevance of increased labor market uncertainty and the continuing male breadwinner norm to emerging patterns of family behavior in East Asia. They illustrate specific ways in which East Asian families are shaped by the joint forces of economic inequality and gender inequality.CONTRIBUTIONThis volume highlights the complexity and heterogeneity of contemporary East Asian families, inviting family and demography researchers to conduct more studies on under-researched family behaviors such as cohabitation and nonmarital births and to revisit the conventional perception that family ties are strong and family support is readily available in East Asia.

Parent/Caregiver Perceptions of Youth Health Outcomes After Participating in the WeCook: Fun With Food and Fitness Program

Many youth programs focused on improving health outcomes have not examined parent/caregiver perceptions postparticipation even though they may significantly influence youth behaviors. The primary purpose of this study was to examine changes in adult perceptions of youth- and family-related behavior after youth participated in a 12-week out-of-school time food preparation, nutrition, and physical activity program with a treatment only design. A secondary objective was to assess differences in survey responses by demographic characteristics. The program targeted fourth- and fifth-grade youth at two Title I elementary schools while also engaging families. Pre- and postprogram surveys were administered to parent/caregivers ( n = 60) across four cohorts spanning the spring 2016 school semester to fall 2017 school semester. Adult demographic characteristics and perceptions of youth- and family-related outcomes were collected. Results demonstrated a significant increase ( p value <.05) in adults’ perceptions of their youth’s ability to choose healthy snacks and decrease screen time. Additionally, lower income adults reported increased youth sedentary habits, adults using food assistance reported decreased family breakfast frequency, and adults with smaller household sizes reported decreased youth activity before school. Further research is needed on adult and family outcomes from youth cooking programs to better understand the adult and youth health relationship and encourage obesity prevention programs to increase their focus on the family component and associated assessments.

Meeting online and family-related outcomes: evidence from three German cohorts

ABSTRACT In recent years, the Internet has become an increasingly important venue for meeting partners. While meeting online may have a range of effects on family-related outcomes, studies on the link between meeting online and family-related outcomes are scarce. Using eight follow-up waves of the German Family Panel (Pairfam), with observations from 8177 persons from three birth cohorts between 2009 and 2016, this study investigates whether meeting online is associated with relationship satisfaction, intention to separate, separation, moving in together, intentions to have a child, and entry into parenthood. More specifically, a series of between-person regressions are used to compare those who met their partners offline and those who met their partners online. Results show that meeting online is associated with likelihood to separate and intentions to have a child in the youngest birth cohort, and transition to parenthood in the oldest birth cohort. These findings are discussed with the concepts of selectivity and intentionality in searching for and meeting partners online.

A multiple baseline study of a brief alcohol reduction and family engagement intervention for fathers in Kenya.

To evaluate a lay provider-delivered, brief intervention to reduce problem drinking and related family consequences among men in Kenya. The 5-session intervention combines behavioral activation (BA) and motivational interviewing (MI). It integrates family-related material explicitly and addresses central cultural factors through gender transformative strategies. A nonconcurrent multiple-baseline design was used. We initiated treatment with 9 men ages 30 to 48 who were fathers and screened positive for problem drinking; the median Alcohol Use Identification Test score was 17 (harmful range). Participants were randomized to staggered start dates. We measured the primary outcome of weekly alcohol consumption 4 weeks before treatment, during treatment, and 4 weeks posttreatment using the Timeline Followback measure. Secondary outcomes were assessed using a pre-post assessment (1-month) of men's depression symptoms, drinking- and family-related problem behavior, involvement with child, time with family, family functioning, relationship quality (child and partner), and harsh treatment of child and partner. Men, partners, and children (ages 8-17) reported on family outcomes. Eight men completed treatment. Mixed-effects hurdle model analysis showed that alcohol use, both number of days drinking and amount consumed, significantly decreased during and after treatment. Odds of not drinking were 5.1 times higher posttreatment (95% CI [3.3, 7.9]). When men did drink posttreatment, they drank 50% less (95% CI [0.39, 0.65]). Wilcoxon signed-ranks test demonstrated pre-post improvements in depression symptoms and family related outcomes. Results provide preliminary evidence that a BA-MI intervention developed for lay providers may reduce alcohol use and improve family outcomes among men in Kenya. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Relationship Between Perceived Discrimination and School/Work–Family Conflict Among Graduate Student-Parents

Work–family conflict (WFC) is commonly experienced by individuals who have roles in both the work and family domains including graduate students with children and/or dependents. Graduate student-parents have the additional strain of school, which can contribute to school–family conflict (SFC) as well. The purpose of this study was to examine whether burnout mediates the deleterious effects of parent-based discrimination on work- and family-related outcomes. We used a mediation modeling design to test whether the distal effects of such bias occur due to increased levels of burnout. Results indicated that burnout mediated the relationship between perceived discrimination and SFC and WFC. The control variables of gender, number of children, year in academic program, and residency status did not significantly predict burnout, SFC, or WFC. Practical and clinical implications are discussed in addition to suggestions for future research.

95 Goals-Of-Care and Advance Care Planning Discussions with Hospitalised Frail Older People: What is the Evidence?

Abstract Introduction National guidelines suggest that patients in the last year of life should be identified, their prognosis and future care options discussed, with advance care planning (ACP) recorded. Goals-of-care should be discussed with hospitalised patients at risk of deteriorating or with life-limiting conditions. The stated purpose of ACP and goals-of-care discussions is to increase goal-concordant care (i.e. patients receiving treatments they would wish to receive, and not receiving those they would not want). This literature review investigates the evidence-base for these policies and outcomes. Review question What is the evidence for goals-of-care and ACP discussions with hospitalised frail older people? Methods Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO, and Embase databases from January 1990 to September 2017. An updated search until May 2019 is currently underway. Results Of 8077 unique articles identified, 17 met inclusion criteria. There is no evidence that goals-of-care discussions lead to increased goal-concordant care; there is observational evidence that they increase the accuracy of documented preferences. Currently, rates of goals-of-care discussions are variable (38-72%), and there is poor concordance between patients’ actual and documented preferences, with agreement in only 31-33% of cases. Present rates of ACP are very low (0-3%), with mixed evidence for benefits of ACP. One single-centre randomised controlled trial suggests ACP improves outcomes for patients who die within 6 months of discharge, including increased goal-concordant care and reduced family distress. There is very limited evidence concerning patients’ and family members’ experiences of these discussions, their reasons for wishing (or not) to participate in discussions, or their perceptions of the important outcomes. Most (80%) patients would like to be involved in decisions about their care; 48% consider these conversations very important. The views and experiences of healthcare professionals have been little studied. Conclusions The asserted aim of goals-of-care and ACP discussions is to increase goal-concordant care; the extent to which this reflects patients’ priorities is unknown. In younger patient populations, while 40% of patients consider goal-concordant care the most important outcome, one third of patients consider family-related outcomes to be more important. Further research is needed to understand the perspectives of frail older patients, their families and clinicians, in order to make these discussions and subsequent care truly patient-centred.

Values, Spirituality and Religion: Family Business and the Roots of Sustainable Ethical Behavior

The inclusion of morally binding values such as religious—or in a broader sense, spiritual—values fundamentally alter organizational decision-making and ethical behavior. Family firms, being a particularly value-driven type of organization, provide ample room for religious beliefs to affect family, business, and individual decisions. The influence that the owning family is able to exert on value formation and preservation in the family business makes religious family firms an incubator for value-driven and faith-led decision-making and behavior. They represent a particularly rich and relevant context to re-assess the relationship between ethical beliefs, decision-making processes and behaviors in business organizations at the interface between family and professional logics. This Special Issue is dedicated to deepening our understanding of the role religious values and spirituality play in the formation of organizational ethical practices in faith-led family firms and resulting organizational and family-related outcomes. In this editorial, we introduce the 10 papers included in this Special Issue, which investigate the relationship between religion or spirituality and family firm ethical behavior in various geographical, cultural and religious contexts, using a multitude of qualitative and quantitative methodologies. By focusing on the effects of religious or spiritual orientations on both the business and the family, as well as on the values, norms and goals present in the family business system, further research can gain a more nuanced understanding of the relationship between religious and spiritual believes, and sustainable ethical behavior in family firms.

Parents’ views about factors facilitating their involvement in the oral early intervention services provided for their children with hearing loss in Kuwait

ObjectivesDeveloped countries (such as the Unites States of America, the United Kingdom, and Australia) provide high-quality services to children with hearing loss and their parents, including universal newborn hearing screening, early fitting of hearing devices and access to high quality early, aural intervention. In contrast, many developing countries lack the resources to provide these services. Research evidence suggests that one way to compensate for delays in identification and rehabilitation for children with hearing loss is to involve the family in the early intervention process. However, evidence is deficient around the facilitation of parental involvement in early intervention for families from developing countries. The aim of this study was to investigate the perception of parents from a developing country who have a child with hearing loss to discover the factors that may influence their involvement in early intervention, identify facilitators/barriers for their involvement, and identify the specific needs of involved parents. MethodA qualitative collective case study methodology was used in the form of semi-structured interviews with twenty-one participants. ResultsTwo global themes emerged. Firstly, factors influencing parental involvement. This included five subthemes: better communication as the key to building rapport and providing support; disappointment with the service; physical and human resources make a difference; consideration of life beyond the habilitation sessions; and my child matters the most. The second global theme-parental needs-included four subthemes: building trust; ensuring generalization; improving child outcomes; and managing needs of parents versus services. All the discussed themes are supported by quotations from the interviews. ConclusionThe findings suggest that parents of children with hearing loss in developing countries perceive the services provided for their children to be disjointed and not well coordinated. Based on the parent perceptions a set of guidelines that provide a scaffold for service providers working with children with hearing loss in developing countries is outlined. The guidelines are designed to assist services for children with hearing loss in developing countries improve the delivery of their services and increase family involvement, which in turn; will assist in improving their child and family related outcomes.

Predicting Work-Family Balance: A New Perspective on Person-Environment Fit.

Work–family balance continues to be a burgeoning topic of organizational research, yet, while the various antecedents of work–family balance have been identified, researchers have, to date, neglected the effect of congruence versus incongruence with regard to work–family integration preferences and the corresponding supplies at work. The current research investigates whether work–family integration preferences and organizational supplies jointly affect work–family balance, and the distal family–related outcomes including marital satisfaction and family functioning, from a person–environment fit perspective. Polynomial regression analysis and response surface methodology are used to test the study’s hypotheses. Results of the polynomial regressions on 393 employees are found to support the congruence effect hypotheses. In particular, the results show that employee work–family balance is higher when work–family integration preferences and organizational supplies are congruent, as opposed to incongruent. An individual’s balance is higher when preferences and supplies are aligned at higher levels rather than at lower levels. In addition, the asymmetrical shape of the surface along the incongruence line indicated that an employee’s work–family balance tends to be damaged once organizational supplies exceed personal preferences. Moreover, through creating a block variable based on the five polynomial terms, we found that congruence/incongruence in respect of work–family integration preferences and supplies yields distal effects on both family functioning and marital satisfaction. Our findings support our hypotheses and are also in line with both person–environment fit theory and balance theory. Theoretical and practical implications for keeping work-family balance are also discussed.

Association of Surrogate Decision-making Interventions for Critically Ill Adults With Patient, Family, and Resource Use Outcomes

Physicians often rely on surrogate decision-makers (SDMs) to make important decisions on behalf of critically ill patients during times of incapacity. It is uncertain whether targeted interventions to improve surrogate decision-making in the intensive care unit (ICU) reduce nonbeneficial treatment and improve SDM comprehension, satisfaction, and psychological morbidity. To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to determine the association of such interventions with patient- and family-centered outcomes and resource use. A search was conducted of MEDLINE, Embase, and other relevant databases for potentially relevant studies from inception through May 30, 2018. Randomized clinical trials studying interventions that were targeted at SDMs or family members of critically ill adults in the ICU were included. Key search terms included surrogate or substitute decision-maker, critically ill, randomized controlled trials, and their respective related terms. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent, blinded reviewers independently screened citations and extracted data. Random effects models with inverse variance weighting were used to pool outcomes data when possible and otherwise present findings qualitatively. Outcomes of interest were divided into 3 categories: (1) patient-related clinical outcomes (mortality, length of stay [LOS], duration of life-sustaining therapies), (2) SDM and family-related outcomes (comprehension, major change in goals of care, incident psychological comorbidities [posttraumatic stress disorder, anxiety, depression], and satisfaction with care), and (3) use of resources (cost of care and health care resource use). Of 3735 studies screened, 13 RCTs were included, comprising a total of 10 453 patients. Interventions were categorized as health care professional led (n = 6), ethics consultation (n = 3), palliative care consultation (n = 2), and media (n = 1 pamphlet and 1 video). No association with mortality was observed (risk ratio, 1.03; 95% CI, 0.98-1.08; P = .22). Intensive care unit LOS was significantly shorter among patients who died (mean difference, -2.11 days; 95% CI, -4.16 to -0.07; P = .04), but not in the overall population (mean difference, -0.79 days; 95% CI, -2.33 to 0.76 days; P = .32). There was no consistent difference in SDM-related outcomes, including satisfaction with care or perceived quality of care (n = 6 studies) and incident psychological comorbidities (depression: ratio of means, -0.11; 95% CI, -0.29 to 0.08; P = .26; anxiety: ratio of means, -0.08; 95% CI, -0.25 to 0.08; P = .31; or posttraumatic stress disorder: ratio of means: -0.04; 95% CI, -0.21 to 0.13; P = .65). Among 6 trials reporting effects on health care resource use, only 1 nurse-led intervention observed a significant reduction in costs ($75 850 control vs $51 060 intervention; P = .04). Systematic interventions aimed at improving surrogate decision-making for critically ill adults may reduce ICU LOS among patients who die in the ICU, without influencing overall mortality. Better understanding of the complex processes related to surrogate decision-making is needed.

P84 Parent/Caregiver Perceptions of Youth Health Outcomes After Participating in the WeCook: Fun with Food and Fitness Program

Objective To assess whether adult involvement in a youth cooking intervention program resulted in improvements of adult perceptions of youth nutrition and activity knowledge and behaviors and family-related outcomes. A second objective was to examine adult responses for differences by income, food assistance use, and household size. Use of Theory or Research Many strategies for childhood obesity prevention have included experiential cooking programs involving parents in various ways. However, evidence is lacking on parent involvement, perceptions, and outcomes. Target Audience Fourth and 5th grade youth at two Title I elementary schools and their families. Program Description The WeCook: Fun with Food and Fitness program was a 12-week, out-of-school time food preparation, nutrition and physical activity program that also engaged families in a comprehensive, multifaceted approach. Evaluation Methods Pre- and post-surveys were administered to youth and their parent/caregiver. Sixty matched youth and adult surveys were included in the analysis. The program was a treatment-only design. Results Results demonstrated a significant increase in adults’ perceptions of their youth's ability to choose healthy snacks and be more active. Further analysis demonstrated significant differences between adult reported demographic characteristics. Lower income adults reported increased youth sedentary habits, adults using food assistance reported decreased family breakfast frequency, and adults with smaller household sizes reported decreased youth activity before school. Youth reported increases in their nutrition and physical activity knowledge, ability to choose healthy snacks, and consumption of sweets post-program. Adult and youth responses at post-assessment were positively correlated in the areas of healthy eating and activity behaviors, such as the perceived ability of youth to eat fruit and healthy snacks, choose water instead of sweetened beverages, and be active after school. Conclusions Further research is needed on adult and family outcomes from youth cooking programs to understand the adult and youth health relationship and encourage obesity prevention programs to increase their focus on the family component and associated assessments. Funding USDA.

Important Outcomes for Parents of Critically Ill Children.

Important Outcomes for Parents of Critically Ill Children.