Abstract
BACKGROUND: Family voice interventions have emerged as a non-pharmacological approach for delirium prevention; however, evidence regarding their effectiveness remains inconsistent. AIM: The aim of this study was to evaluate the effectiveness of family voice interventions in reducing delirium among adult intensive care unit (ICU) patients. STUDY DESIGN: We conducted a systematic review and meta-analysis. A comprehensive literature search was conducted across PubMed, EMBASE, CINAHL and the Cochrane Library from inception through 4 March 2025. Study quality was assessed using the Cochrane Risk of Bias II tool, with analyses performed using Comprehensive Meta-Analysis version 4.0. RESULTS: Six randomised controlled trials (reported across seven publications) involving 598 adult ICU patients were included. Family voice interventions significantly reduced delirium incidence (OR = 0.282, 95% CI: 0.126-0.630, p = 0.002) and duration (Hedges' g = -1.929, 95% CI: -2.980 to -0.879, p < 0.001). No significant effects were observed for mechanical ventilation duration (Hedges' g = -0.826, 95% CI: -1.696 to 0.044, p = 0.063) or ICU length of stay (Hedges' g = -0.534, 95% CI: -1.371 to 0.303, p = 0.211). Subgroup analysis showed multicomponent interventions significantly reduced both delirium incidence (OR = 0.178, 95% CI: 0.046-0.681, p = 0.012) and duration (Hedges' g = -1.888, 95% CI: -2.917 to -0.859, p < 0.001), while single-component interventions showed no significant effects. CONCLUSIONS: Family voice interventions effectively reduce delirium incidence and duration in adult ICU patients, with multicomponent approaches demonstrating superior efficacy. RELEVANCE TO CLINICAL PRACTICE: Critical care nurses may incorporate family voice interventions as a practical alternative within delirium prevention strategies. Although direct family presence is generally regarded as the preferred form of engagement, recorded voice messages can provide a feasible and meaningful option to enhance patient orientation and emotional connection when families cannot always be present. PROTOCOL REGISTRATION: The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42025628074).