Abstract
OBJECTIVE: To determine the characteristics and effectiveness of nurse-led family communication interventions in the ICU. DATA SOURCES: PubMed, Web of Science, PsychInfo, CINAHL, Embase, Cochrane Library, and relevant article citations from January 1995 to July 2025. STUDY SELECTION: We included randomized controlled trials (RCTs) and quasi-experimental studies evaluating nurse-led family communication interventions in adult ICUs. DATA EXTRACTION: Two independent reviewers assessed evidence levels and risk of bias using the Cochrane tool and the Joanna Briggs Institute's Critical Appraisal Tools. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines, and interventions were summarized with the Template for Intervention Description and Replication Checklist. DATA SYNTHESIS: Seven RCTs and seven quasi-experimental studies were included. The most common nurse-family communication model was an in-person, structured, and dynamically tailored intervention during the patient's ICU stay. Nurses played five core roles: information delivery and clarification, emotional support, family assessment, family meeting facilitation, and transitional support. Bedside ICU nurses led information delivery and multidimensional family assessments. Internal research nurses handled information clarification, structured needs assessment, and family meeting coordination. External research nurses focused on family meeting support, structured emotional support, and transitional care. Although the interventions may improve communication quality (standardized mean differences [SMD] = 0.26) and reduce hospital length of stay (LOS) (mean differences [MD] = -3.87 d), they appear to have limited effects on psychologic distress, satisfaction, ICU LOS, or mortality; they may also increase family meeting frequency/duration and lower overall costs. CONCLUSIONS: The conclusions of our systematic review are limited by considerable heterogeneity in intervention intensity, implementer profiles, and adaptation descriptions. Future interventions should define optimal dosage and outline best practices for evidence-based intervention tailoring and implementation. Healthcare institutions should integrate specialized nursing roles, such as training bedside nurses or establishing dedicated communication facilitators. This approach may leverage nurses' expertise to enhance communication quality and improve outcomes.