In Australia’s intensive care units, where clinical decisions can mean the difference between life and death, families are often more than just visitors — they are partners, advocates, and vital sources of insight. As ICU care becomes increasingly complex, so too does the challenge of involving families meaningfully, compassionately, and consistently.

While ethics and end-of-life decisions often dominate the conversation, there’s growing recognition that family-centred care is just as much about systems as it is about values — and there are practical tools that ICU teams can use to get it right.

Research shows that supporting families well isn’t just a moral good — it’s clinically beneficial. A 2020 qualitative study in Australian Critical Care found that when families were kept informed and included in patient care, their experience of ICU was less traumatic, even in the face of deterioration or death. Participants described feeling more confident, more emotionally supported, and better able to cope with the critical illness of a loved one when communication was clear and inclusive.These findings echo a growing body of local and international evidence: when families feel they are part of the team — not just bystanders — their psychological outcomes and trust in care improve.

This philosophy is embedded in national policy. The National Safety and Quality Health Service (NSQHS) Standards, particularly Standard 2, call on health services to embed “partnering with consumers” at every level of care. In the ICU context, this includes not just inviting families to bedside discussions, but building systems that allow for meaningful participation — including structured meetings, culturally safe communication tools, and feedback mechanisms that shape practice.

From Principles to Practice: What Inclusion Looks Like

One of the clearest examples of system-level change is the structured family meeting. In Australian ICUs, these are increasingly multidisciplinary, involving not only medical staff but also nurses, social workers, and, where appropriate, interpreters or cultural liaison officers. Tools like the VALUE mnemonic — Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, and Elicit questions — have become widely accepted as a framework for these conversations.

A multicentre ICU trial by Curtis et al. (2016) found that use of structured communication interventions — including VALUE — significantly reduced depression symptoms and PTSD among family members of critically ill patients.

Another emerging tool in Australian ICUs is the ICU diary. Originally designed to reduce patient delirium and memory gaps post-ICU, diaries also serve as a bridge for families, especially during prolonged admissions or shift changes.

A 2024 Australian study of ICU nurses found that, although use of diaries is still emerging, these clinicians view them as a valuable care tool and are “optimistic about their positive impact on both patients and families.”

Other low-cost initiatives include bedside whiteboards for family questions, “meet the team” information posters, and pre-printed family update sheets to help structure key daily information. Some ICUs are also trialling the use of secure digital portals that allow families to receive non-clinical updates or request video calls — a tool that proved critical during the COVID-19 pandemic and continues to support remote or rural families.

Measuring Experience, Not Just Outcomes

To capture the real impact of these tools, many ICUs now use family experience measures such as the FS-ICU-24R (Family Satisfaction in the ICU – 24-item Revised). These surveys assess family perceptions of communication, involvement in decision-making, emotional support, and respect for the patient. The 2022 ANZICS CORE Report highlights growing national interest in using FS-ICU 24R to benchmark care quality across sites and support service improvement strategies.

Making Space for Cultural and Emotional Safety

Family-centred care is not one-size-fits-all. For Aboriginal and Torres Strait Islander families, inclusion must reflect kinship systems, extended family roles, and spiritual needs — particularly at the end of life. The NSQHS User Guide for Aboriginal and Torres Strait Islander Health identifies culturally safe communication and respect for family structure as central to high-quality care.

Similarly, rural and remote families often face long-distance separations, financial strain, and logistical barriers to being present at the bedside. Studies have shown that these families benefit from regular, structured communication — including telehealth-supported updates — and flexible visiting policies where feasible.

The Case for Investing in Inclusion

Effective family engagement in ICU doesn’t just happen — it requires time, training, and cultural support. Staff must feel equipped to hold emotionally difficult conversations and supported by institutional policies that value this work. When ICU teams are resourced to do this well, families feel heard, patients receive care that better reflects their values, and clinicians report reduced moral distress.

In a space as high-stakes and emotionally charged as the ICU, involving families is not just an ethical obligation — it's a clinical competency. The tools are there, and so is the evidence. What matters now is creating the time, space and support for ICU teams to embed family-centred care into everyday practice. Because when families are meaningfully included, everyone benefits — especially the patient.