Abstract
A recent systematic review and meta-analysis of randomized trials evaluating digital health interventions for family members of intensive care unit (ICU) patients found no significant improvements in anxiety, depression, posttraumatic stress, quality of life, or communication quality. Rather than concluding that digital approaches are inherently ineffective, we argue that these null findings reflect identifiable and remediable limitations in intervention design, outcome measurement, and trial methodology. In this commentary, we examine four structural barriers that currently constrain the evidence base and outline the conditions that next-generation trials must meet to adequately address the questions raised by this review.