The Family Perspectives Project Pilot Trial

Inclusion criteria

• Patient inclusion criteria:
• Individuals 18 years old or older.
• Individuals admitted to the medical intensive care unit (MICU) at Cedars-Sinai Medical Center.
• Individuals with acute respiratory failure, defined as \>24 hours of invasive mechanical ventilation.
• Individuals who received invasive mechanical ventilation within 24 hours of admission to the MICU.
• Individuals expected to need invasive mechanical ventilation for \>72 hours total, as determined by the patient's intensivist physician (fellow or attending).
• Primary surrogate decision maker inclusion criteria: o Individuals 18 years old or older.
• Individual who self-identifies as the most responsible for making decisions for the enrolled patient (can be either family member or close friend).
• Proficiency in English language.
• ICU support counselor inclusion criteria:
• Individuals 18 years old or older.
• Individuals who work as hospital chaplains in the MICU.
• Physician (intensivist) inclusion criteria:
• Individuals 18 years old or older.
• Individuals who work as critical care physicians in the MICU (fellow or attending).
• Nurse inclusion criteria:
• Individuals 18 years old or older.
• Individuals who work as bedside nurses in the MICU.
• Social worker inclusion criteria:
• Individuals 18 years old or older.
• Individuals work as social workers in the MICU.

Exclusion criteria

• Patient exclusion criteria: o Any records flagged "break the glass" or "research opt out." o Individuals expected to die within 24 hours of potential enrollment, as determined by the patient's intensivist physician (fellow or attending). o Individuals on comfort care protocol or with clear preference for comfort care, as determined by the patient's intensivist physician (fellow or attending).
• Individuals who are chronically dependent on a ventilator prior to admission.
• Individuals with acute on chronic neuromuscular disease-related respiratory failure (e.g., Guillain Barre, Muscular Dystrophy, Myasthenia Gravis, etc.).
• Individuals imminently awaiting organ transplant, as determined by the patient's intensivist physician (fellow or attending).
• Individuals with decisional capacity, as determined by the patient's intensivist physician (fellow or attending).
• Individuals who are unrepresented (i.e., patient has no surrogate decision maker).
• Individuals whose potential enrolled family member (primary surrogate decision maker) is not proficient in English.
• Individuals whose attending physician is the PI on this study at the time of potential enrollment.
• Individuals who are cared for by intensivist physicians (fellow and attending) who do not agree to participate in the study.
• Individuals who have a pre-existing relationship with a hospital chaplain who does not agree to participate in the study, as determined by that chaplain.
• Primary surrogate decision maker exclusion criteria: o Not proficient in English language. (Rationale: materials and intervention are not adapted in other languages.)
• ICU support counselor exclusion criteria: o None
• Physician (intensivist) exclusion criteria: o None
• Nurse exclusion criteria: o None
• Social worker exclusion criteria: