Measuring the satisfaction of intensive care unit patient families in Morocco: A regression tree analysis* Nada Damghi, MD; Ibtissam Khoudri, MD; Latifa Oualili, MD; Khalid Abidi, MD; Naoufel Madani, MD; Amine Ali Zeggwagh, MD, PhD; Redouane Abouqal, MD, PhD I n critical care, the quality of care has traditionally focused on the provider, the process of care, and patient outcomes (1). Critical ill- ness and subsequent hospitalization in an intensive care unit (ICU) often occur without any warning, leaving little time for patients or their families to prepare. It is a catastrophic event for families, creating emotional upsets, anxiety, uncertainty, and fear of losing a loved one. ICU physicians have then to be concerned not only with patients’ health status, but also with the psychosocial needs of their families. Because the family members often un- dergo psychologic crises, numerous studies (1–13) from both the United States and Europe have documented the needs of fam- ily members of critically ill patients. The family needs are acknowledged as a priority of ICU physicians or nurses and an initial step in providing appropriate care for both families and patients (1–3). Psychologic assurance from ICU physi- cians has been shown to induce a sense of being cared for along with a sense of secu- rity and hope in families undergoing a life crisis. Healthcare professionals are then asked to provide clear and appropriate in- formation to involve the family members in making decisions about patients in the ICU. The results of studies (1–13) suggested that information-giving is one of the most effec- tive means of communication and the cor- nerstone of successful crisis intervention with families of patients in ICUs. Family satisfaction increases with clear informa- tion. Also, in some cases, the need for hope, reassurance, and proximity to the patient seems as important as the need for com- munication. Several questionnaires have been de- veloped to measure the satisfaction of patients’ family members (1, 14 –16). The Society of Critical Care Medicine’s Family Needs Assessment questionnaire *See also p. 2204. From the Medical Intensive Care Unit (ND, IK, LO, KA, NM, AAZ, RA), Ibn Sina University Hospital, Rabat, Morocco; and the Laboratory of Biostatistics, Clinical and Epidemiological Research (AAZ, RA), Faculty of Medicine, Rabat, Morocco. The authors have not disclosed any potential con- flicts of interest. ND and IK contributed equally to this work. For information regarding this article, E-mail: abouqal@invivo.edu Copyright © 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins DOI: 10.1097/CCM.0b013e31817c104e Objective: Meeting the needs of patients’ family members becomes an essential part of responsibilities of intensive care unit physicians. The aim of this study was to evaluate the satisfaction of patients’ family members using the Arabic version of the Society of Critical Care Medicine’s Family Needs Assessment questionnaire and to assess the predictors of family satisfaction using the classification and regression tree method. Design: The authors conducted a prospective study. Setting: This study was conducted at a 12-bed medical inten- sive care unit in Morocco. Patients: Family representatives (n  194) of consecutive patients with a length of stay >48 hrs were included in the study. Intervention: Intervention was the Society of Critical Care Medicine’s Family Needs Assessment questionnaire. Measurements and Main Results: Demographic data for rela- tives included age, gender, relationship with patients, education level, and intensive care unit commuting time. Clinical data for patients included age, gender, diagnoses, intensive care unit length of stay, Acute Physiology and Chronic Health Evaluation, MacCabe index, Therapeutic Interventioning Scoring System, and mechanical ventilation. The Arabic version of the Society of Crit- ical Care Medicine’s Family Needs Assessment questionnaire was administered between the third and fifth days after admission. Of family representatives, 81% declared being satisfied with infor- mation provided by physicians, 27% would like more information about the diagnosis, 30% about prognosis, and 45% about treat- ment. In univariate analysis, family satisfaction (small Society of Critical Care Medicine’s Family Needs Assessment questionnaire score) increased with a lower family education level (p  .005), when the information was given by a senior physician (p  .014), and when the Society of Critical Care Medicine’s Family Needs Assessment questionnaire was administered by an investigator (p  .002). Multivariate analysis (classification and regression tree) showed that the education level was the predominant factor contributing to the Society of Critical Care Medicine’s Family Needs Assessment questionnaire score. Society of Critical Care Med- icine’s Family Needs Assessment questionnaire increased (greater satisfaction) with a higher education level. Other factors of great satisfaction included the senior physician providing the information, and Acute Physiology and Chronic Health Evaluation <15. Conclusions: Satisfaction of intensive care unit patients’ fam- ilies in a Moroccan sample using the classification and regression tree was dependent on relatives’ education level, communication presented by senior caregiver, and low Acute Physiology and Chronic Health Evaluation score. These data underline cultural specificities of the study and suggest that caregivers should develop structured communication programs considering satis- faction predictors. (Crit Care Med 2008; 36:2084 –2091) KEY WORDS: critical care; family needs; satisfaction; Arabic version; Society of Critical Care Medicine’s Family Needs Assess- ment; tree-based analysis 2084 Crit Care Med 2008 Vol. 36, No. 7