Family Automated Voice Reorientation (FAVoR)

A four-year, $1.94 million study, funded by the NIH’s National Institute of Nursing Research, will test the impact of Family Automated Voice Reorientation (FAVoR) on delirium in patients in intensive care.


Family Automated Voice Reorientation (FAVoR) is a new study that explores whether scripted audio messages recorded by a family member can help to prevent delirium in critically ill, mechanically ventilated ICU patients by providing them with ongoing orientation to the ICU environment. Funded by the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH), the four-year, $1.94 million randomized clinical trial will test whether recorded messages enable patients to interpret the ICU environment more accurately and help them improve their day/night orientation and nighttime sleep, thus reducing the risk of delirium. The nursing-oriented FAVoR intervention provides an innovative, non-pharmacological approach to addressing delirium.

“Traditional medical care in the ICU has focused on pharmacological management of delirium,” says principal investigator and School of Nursing and Health Studies (SONHS) Dean and Professor Cindy Munro, Ph.D., R.N., ANP-BC, FAAN, FAANP, FAAAS. “But because our intervention has a strong nursing care focus, it has the potential to affect delirium in ways that are distinct from, yet synergistic with medical care.”

More than 5.7 million patients are admitted to ICUs each year in the U.S. The cramped, technologically advanced ICU patient room is an unfamiliar, stressful environment for patients and their families. Patients may feel frightened, alone and confused, and family members may neglect their own self-care while feeling as if there is little they can do to help their loved one. FAVoR is designed to reassure and orient the patient while literally giving family members a voice in their care.

“FAVoR gives family caregivers permission to leave the patient’s bedside, to go to the cafeteria or go home to get some much-needed rest,” says FAVoR project coordinator Paula Cairns. “It allows caregivers to engage in self-care, knowing their voices will be there to help soothe and orient the patient.”

Patients participating in FAVoR are randomly assigned to intervention and control groups. FAVoR is being implemented in both medical and surgical ICUs so that a full range of ICU patients and problems are included, thus ensuring that the results have broad applicability across ICU settings and medical conditions. The study includes both female and male adult participants at all age levels to explore whether certain groups respond better to the intervention. Because many variables in the ICU may influence outcomes, the study design controls for variations between patients, including type of illness, relationship to the family member recording the messages, and direct interaction with nurses and family members.

Beyond its approach to preventing delirium in ICU patients, FAVoR’s innovative contributions to the field will also include assessments of patients’ 24-hour sleep patterns and cognitive function. “This will be the first time continuous sleep data will be available for ICU patients,” says Munro. Patients’ cognitive function and memory will also be measured following their transfer out of ICU and again after they return home.

The foundation for the current clinical trial is a pilot study Munro conducted using recorded messages in a familiar voice. The pilot study demonstrated that ICU patients who heard the messages were better oriented and had more favorable outcomes than control group patients who did not hear any messages.

For Munro and Cairns, FAVoR is only the beginning, offering potential applications for other populations, such as pediatric and dementia patients, as well as the possibility of applications in resource-challenged regions outside the U.S. that could advance UM’s global and hemispheric impact. “By partnering with families to help these most vulnerable patients,” says Cairns, “we’re helping not only to prevent delirium, but also empowering families to be an integral part of their loved ones’ care and recovery.”

 

Read the full story in the Spring 2018 issue of Heartbeat magazine.