Federally funded trial tests an app for the ICU's 'hidden patients'

A new federally funded trial will test whether a tablet app can ease the psychological toll on people forced to make life-and-death choices for a relative in intensive care. With a $3.26 million grant from the National Institute on Aging, Case Western Reserve nursing researcher Grant Pignatiello will enroll 387 surrogate decision-makers of critically ill ICU patients aged 35 and older at University Hospitals Cleveland Medical Center. Half will use REFRAME, an app that teaches 'cognitive reappraisal'—recognizing distressing emotions and reframing them so they become more manageable—in brief 10-to-15-minute modules; the comparison group watches ICU-focused educational videos. Researchers will measure depression, post-traumatic stress, and decisional regret one to two days after the intervention and again three months later. Surrogates often step in with little preparation and enormous pressure, and many later experience anxiety, guilt, and PTSD symptoms. 'Families can become the hidden patients of critical illness,' Pignatiello said. The trial begins later this year.