Impact of a Volunteer‐Delivered Spiritual Care Strategy on Preventing Post‐Intensive Care Syndrome‐Family in Relatives of Critically Ill ICU Patients: A Quasi‐Experimental Study

ABSTRACT

Background

Family members of critically ill patients are at increased risk of developing psychological disorders after ICU discharge, a condition known as Post‐Intensive Care Syndrome‐Family (PICS‐F). Spiritual care (SC) interventions may reduce this burden, yet are rarely studied in this context.

Aim

To assess the effect of a volunteer‐delivered spiritual care intervention on the prevention of PICS‐F, specifically post‐traumatic stress disorder (PTSD), anxiety, and depression in relatives of ICU patients.

Study Design

We conducted a quasi‐experimental pre‐post intervention study in a Chilean ICU. The intervention comprised three structured spiritual care sessions delivered virtually by trained community volunteers using the FICA tool. The primary outcome was PTSD symptoms, measured with the IES‐R scale. Secondary outcomes included anxiety and depression (HADS) and satisfaction with the intervention. Given the protective role of family support during ICU stays against PICS‐F, a non‐randomised prospective study was designed. This study aimed to prevent psychological disorders related to PICS‐F by providing support to family members of critically ill patients. It was hypothesised that a systematic general spiritual care intervention compared to standard care would effectively reduce psychological disorders associated with family post‐ICU syndrome within 3 months.

Results

A total of 125 family members participated (n = 64 in the control group, n = 61 in the intervention group). After the intervention, significant differences were observed in PTSD scores (OR = 0.067; CI 0.010–0.458). This was not the case for depression or anxiety. Satisfaction with the intervention was high.

Conclusions

A structured spiritual care intervention delivered by trained community volunteers was feasible and associated with reduced psychological distress in ICU family members. This low‐cost and scalable spiritual care intervention, delivered virtually by trained volunteers, demonstrates feasibility and acceptability in ICU settings, particularly in resource‐limited contexts.

Relevance to Clinical Practice

This study demonstrates that a structured, non‐denominational spiritual care intervention can significantly reduce symptoms of post‐traumatic stress in family members of ICU patients. By integrating generalist spiritual support into ICU family care, delivered by trained volunteers using telehealth platforms, critical care teams can offer compassionate, accessible, and scalable support that addresses emotional and existential suffering. These findings highlight the importance of integrating spiritual care into multidisciplinary approaches to prevent PICS‐F and promote holistic, family‐centred care in intensive care settings.

Impact Statement

• What is known about the topic?

  • ○
    Family members of ICU patients frequently develop psychological symptoms, including anxiety, depression, and PTSD, collectively described as Post‐Intensive Care Syndrome‐Family (PICS‐F).
  • ○
    Previous interventions have focused on communication and family conferences, but evidence for their effectiveness in preventing PICS‐F is limited.
  • ○
    Spiritual care is recognised as necessary in critical illness, yet systematic, generalist spiritual interventions for families remain understudied.
• What this paper adds?

  • ○
    A structured generalist spiritual care intervention reduced PTSD symptoms in family members of ICU patients at 3 months, though it did not impact anxiety or depression.
  • ○
    The intervention, delivered remotely by trained volunteers using the FICA model, was found to be feasible, acceptable, and well‐received by caregivers.
  • ○
    This study highlights the potential role of spiritual care as a low‐cost, scalable strategy to support ICU families and prevent aspects of PICS‐F.

1. Introduction

Families of critically ill patients face tremendous burdens when relatives are admitted to the intensive care unit (ICU) [1, 2]. The unknown and often unexpected circumstances, combined with uncertainty about clinical outcomes, can have a profound psychological impact on relatives. This distress may persist from ICU admission to months after the patient's discharge or death [3, 4]. Post‐intensive care syndrome family (PICS‐F) refers to a set of psychological symptoms, including anxiety, acute stress disorder, post‐traumatic stress disorder (PTSD), and complicated grief [2, 5, 6, 7]. This syndrome may hinder the family's ability to support ICU patients' recovery. Families experience fatigue and sleep disturbances post‐UCI, along with financial insecurity from patient care affecting socioeconomic activities, like sick leave and work restrictions [2]. These symptoms can persist for months after ICU discharge, presenting with psychological symptoms such as depression, anxiety, post‐traumatic stress syndrome, affecting 20% to 40%, and fatigue reaching 15% 6 months later [8]. Strategies to prevent PICS‐F have shown positive results through improved communication, family support, and ICU presence [9, 10].

2. Background

Interest in spirituality and spiritual care (SC) in ICUs has increased over the last decade. Although SC has traditionally been associated with end‐of‐life care, ICU admission itself is a profoundly distressing experience that can provoke significant psychological and emotional suffering. Therefore, ICU patients and their relatives may also benefit from receiving SC throughout the ICU stay [11, 12, 13].

Spirituality is a dynamic aspect of humanity in which individuals seek meaning, purpose, and transcendence through relationships with themselves, their families, their communities, and nature. It is expressed through various beliefs, values, traditions, and practices. The three essential elements of SC are ‘connection’, ‘meaning and purpose of life’, and ‘transcendence’ [12]. For many patients facing severe illnesses, spirituality is essential and can influence medical decision‐making [14]. Patients frequently desired SC; however, their spiritual needs are often unaddressed in medical care because spiritual care is infrequent for such patients [13, 14].

Spiritual care addresses the spiritual needs and concerns of patients and relatives that arise in healthcare settings. It relies on a multidisciplinary team (e.g., chaplains, physicians, nurses, and social workers) and requires spiritual history to be included in the comprehensive medical history [14]. SC is linked to hope, meaning, and peace, providing relief for patients facing critical illness [13]. It is recognized as crucial for critically ill patients and their families [15, 16, 17]. In contexts of critical illness, the spiritual dimension has a profound impact on the quality of life for patients and their families, facilitating coping with life‐threatening conditions [17]. Research in ICUs suggests that healthcare professionals view SC positively, noting benefits such as addressing spiritual and emotional needs, providing comfort to distressed patients, enhancing spiritual well‐being, and increasing family satisfaction with ICU care and decision‐making [11, 18].

In the context of spiritual care delivery, international frameworks describe a range of integration models spanning from generalist to specialist approaches between medicine, spirituality, and religion. In high‐income settings, specialist spiritual care is often delivered by formally trained chaplains integrated into clinical pathways [19]. However, this infrastructure is not uniformly available across healthcare systems. In Chile and most Latin American countries, there are no standardised or accredited training programs for professional chaplaincy or specialist spiritual care, and spiritual support for patients and families is typically provided informally and unsystematically. This contextual gap necessitates pragmatic and culturally adapted models of spiritual care delivery.

3. Methodology

3.1. Study Design

This study used a quasi‐experimental before‐and‐after design. Participants were assigned to one of two sequential cohorts based on the timing of their ICU admission relative to the implementation of the spiritual care intervention (see Figure 1). It adheres to the CONSORT extension for pilot and feasibility trials with the recommended adaptations [20, 21, 22].

FIGURE 1.

Flow chart for the quasi‐experimental study design. This figure shows the study design process flow, from the usual care/control group to the implementation of the generalist spiritual care intervention. GSC, generalist spiritual care; IES‐R, impact event revised scale; HADS, hospital anxiety and depression scale.

The pre‐intervention cohort received standard care, while the intervention cohort received the structured spiritual care strategy. No random allocation was performed. During the pre‐intervention stage, family members received the usual spiritual care available in the hospital setting. This consisted of ad hoc visits from the hospital's general chaplain or by pastors from Protestant churches, requested by the staff or the family. No structured or standardised spiritual care process was in place at the time.

In the intervention stage, enrolled participants received a generalist spiritual care (GSC) intervention. GSC consisted of systematic and periodic spiritual care utilising the FICA [23] instrument and included three sessions conducted via Zoom or video call. Volunteers delivered the GSC and had been previously trained to implement the intervention. GSC did not align with any specific creed, as it constituted a trans‐religious intervention.

3.2. Setting and Sample

The study was conducted in the ICU of the Complejo Asistencial Dr. Sótero del Río (CASR) in Santiago, Chile. The CASR is a highly complex public hospital that serves an assigned population of approximately 1.5 million inhabitants [24, 25].

Participants were eligible if they met the following criteria: one caregiver aged at least 18 for each ICU patient under invasive mechanical ventilation (IMV) for at least 48 h and under active management. Exclusions included family members with language barriers or those who were unable to be contacted upon ICU discharge, including those with technological barriers for telematic sessions.

For the sample size calculation, we assumed a 50% prevalence of PTSD among family members of ICU patients, a common issue in PICS‐F [26]. Expecting a 20% decrease in PTSD prevalence after the intervention and accounting for a 20% loss to follow‐up, with 80% power and a 5% significance level, we planned to enrol 124 individuals (62 in each group).

3.3. Data Collection Tools

Family members of ICU patients underwent morning eligibility screenings. Recruited participants were interviewed during the first week of their loved ones' ICU stay for baseline data. Three months later, participants were contacted to evaluate outcomes.

Data were collected using REDCap [27]. Baseline data were collected from family members using a structured questionnaire administered at ICU admission. Variables included age, gender, education level, relationship to the patient, religious affiliation, self‐rated religiosity/spirituality, history of mental health diagnoses (self‐reported), and current use of psychotropic medications during the first week of their loved ones' hospitalisation via telephone. Clinical variables affecting family members' psychological disorders, like ICU length of stay, duration of invasive mechanical ventilation, hospitalisation duration, and mortality, were gathered by a member not involved in patient care.

3.4. Outcomes Measures

We compared study outcomes between the pre‐intervention and intervention cohorts. The primary outcome was the rate of post‐traumatic stress disorder (PTSD) at 3 months post‐recruitment. PTSD was selected as the leading indicator of PICS‐F due to its high prevalence among ICU family members and its sensitivity to early psychological distress. It was assessed using the Impact of Event Scale (IES‐R) (Chilean population version) [28]. This scale has a score range from 0 to 88, defining possible PTSD as a score of 34 or higher, as recommended when used as a self‐report measure.

The secondary outcomes included the prevalence of depressive and anxiety symptoms at 3 months post‐recruitment. The Hospital Anxiety and Depression Scale (HADS) [29] was used, featuring both depression and anxiety subscales. HADS is a self‐assessment tool for emotional distress, specifically anxiety and depression, in a non‐psychiatric cohort. This instrument consists of 14 items and shows strong reliability and validity in Chile for diagnosing and assessing these disorders. It includes two subscales: HAD‐A for anxiety and HAD‐D for depression; each subscale has seven items with scores from 0 to 3. The recommendation is to use the original cut‐off points: a score of 8 indicates possible cases, and a score of 10 or higher indicates probable cases for each subscale. To estimate prevalence, cut‐off scores for probable cases were used, as recommended in previous studies.

Other outcomes include the intervention group's satisfaction with the GSC received during the 3‐month evaluation, assessed through a satisfaction survey (see Appendix S3). The issues included in the survey were: expectations, empathy from the volunteer, feeling heard in the sessions, being recommended for the hospital, and whether the intervention would be recommended. Additionally, the intervention's implementation was assessed. A Likert scale was used, ranging from 1 (completely disagree) to 5 (completely agree).

3.5. Generalist Spiritual Care (GSC) Intervention

The intervention in this study is a structured form of generalist spiritual care delivered by trained volunteers under the supervision of the research team. The volunteers were lay individuals without formal clinical training, recruited through a university‐community partnership program and explicitly trained in spiritual care principles and the adapted FICA model for this study. Although it does not constitute specialist spiritual care, the intervention was designed as an intermediate model between informal generalist support and specialised chaplaincy care. This approach reflects the local healthcare context, where formally trained spiritual care specialists are not routinely available. The role of volunteers was to deliver structured sessions under supervision. The research team remained actively involved throughout the intervention to provide supervision, monitor fidelity, and address situations beyond the scope of volunteer‐delivered support, including referrals to mental health professionals or clergy when indicated.

The study proposed an intervention with three components: (1) a systematic approach using a standardised schedule of three sessions based on the FICA instrument; (2) trained volunteers provided care, essential for its systematic nature; (3) intervention delivered via telematics, using Zoom or video calls. The GSC does not follow any specific creed; instead, it offers spiritual care and attention broadly, honoring the dignity, humanity, individuality, and diversity of people from various cultures, faiths, and beliefs coexisting in society. To ensure compliance with the three characteristics of the GSC, our research team developed four critical components for the intervention: (1) Design of the GSC sessions; (2) Development and implementation of a training program for volunteers; (3) Creation of a manual for volunteers; (4) Creation of a logbook for volunteers.

The intervention dosage entails three GSC sessions. Each GSC session maintained a 1:1 ratio (one family member paired with one companion); each participant was supported by the same volunteer throughout the intervention. Ideally, the intervention was expected to be delivered while the loved one was still in the ICU; however, the final session could take place after discharge, considering the average duration of ICU stays. Each session lasted 45–60 min and was organised by the research team based on the availability of family members and companions.

Regarding spirituality, the sessions used the FICA instrument, developed by Dr. ChristDr Puchalski, to explore spirituality in healthcare [23]. It was initially written in English, then translated and culturally adapted for use in Chile through a structured process led by our team. The adaptation process followed ISPOR guidelines for cultural adaptation. It included direct translation, expert review to ensure conceptual equivalence, and contextual adjustments to reflect local language and cultural expressions of spirituality [30]. The FICA helps people understand one another and explore a person's needs and resources. FICA aims to examine four key dimensions of spirituality (the term FICA is an acronym for these four dimensions):

F: FAITH and beliefs.

I: Importance of faith and beliefs in my life.

C: Community, that is, how important is my community, including my family, group of friends, co‐workers, or other activities, in my living of faith and beliefs.

A: Approach to care. This dimension may vary depending on who applies the FICA.

Examples of possible questions for each FICA dimension are presented in Table 1.

TABLE 1.

Examples of possible questions for each FICA dimension [31].

FICA's dimension	Possible questions
Faith	Do you consider yourself a spiritual or religious person? Are spirituality, religion, or other beliefs in the supernatural or sacred essential to you? Do you have spiritual beliefs that help you overcome stress or cope with difficult times? Does your religion or beliefs influence how you are coping with your hospitalisation in the ICU?
Importance	How important is spirituality or religion in your daily life? Has your spirituality, religion, or beliefs influenced your self‐care? Has your spirituality, religion, or beliefs influenced the decisions you make regarding your health?
Community	Are you part of a spiritual or religious community? Does this community support you in difficult times, and in what way? In this dimension, you can also ask about family or friends as a “nuclear community” and support to face problems and difficult situations: Do you have the support of your relatives now that you have a loved one in the ICU? (for this, it is essential to have previously asked something about the family or about who the participant lives with) Do you have the support of friends at this time (sometimes “the community” is made up of neighbours, members of a senior citizens' club, sports club, etc.)?
Approach to care	How would you like me to support you during these coaching sessions?

Abbreviation: ICU, intensive care unit.

While the FICA framework served as the foundation, each session also included specific goals for the trained volunteer to address. These goals were based on the family member's prior responses and focused on creating meaning, identifying sources of hope, facilitating connection with a spiritual community if relevant, and supporting existential coping. The whole intervention protocol, including session objectives, is presented in Appendix S1 [32, 33].

To ensure ethical delivery of the intervention, volunteers were trained to recognise signs of significant spiritual or emotional distress and instructed not to attempt therapeutic interventions beyond their role. The research team actively monitored the intervention through supervision meetings and review of volunteer logbooks. When needs exceeded the scope of the intervention, predefined referral pathways to mental health professionals or clergy were activated. This oversight aimed to prevent potential harm and ensure participant safety throughout the study.

3.6. Data Analysis

Baseline characteristics are presented as means ± standard deviation, medians (p25‐75), and percentages. Statistical analyses compared numerical variables using the Student's t‐test (parametric) and the Mann–Whitney test (nonparametric), while categorical variables were analysed using the χ ² test. Logistic regression models were employed to evaluate the impact of various variables on primary and secondary outcomes. STATA version 15.1 (College Station, TX) was used to perform the analyses, with a significance level set at p < 0.05.

For this purpose, we only included participants who completed both assessments.

3.7. Ethical and Institutional Approval

This study was approved by the Ethics Committee of the Faculty of Medicine of the Pontificia Universidad Católica de Chile (210111006) on August 5, 2021, and by the Ethics Committee of the Servicio de Salud Metropolitano Sur Oriente on October 21, 2021, which oversees research at the Complejo Asistencial Dr. Sótero del Río. All procedures were conducted in accordance with the Declaration of Helsinki and local ethical guidelines. Informed consent was obtained from all participants included in the study.

4. Results

4.1. Characteristics of the Participants

The screening and enrollment processes were conducted from November 2021 to July 2022. A total of 125 caregivers participated, with 61 individuals in the pre‐intervention stage and 64 in the intervention stage (see Figure 2). As illustrated in Table 2, the baseline characteristics reveal that most subjects in both groups were women (specifically, the wives/partners of the patients) and presented indicators of social vulnerability. Approximately one‐third of the family members had not completed their formal education, and nearly half were unemployed. It is particularly noteworthy that over 20% of the subjects in both cohorts reported a history of mental health issues, and more than 80% of them identified as religious, with the majority being Catholic or Christian. There were no statistically significant differences in the baseline characteristics between the two groups.

FIGURE 2.

Participants flow diagram. This figure illustrates the total number of participants (n = 125), the number per group, and the final sample size. GSC, generalist spiritual care.

TABLE 2.

Comparison of relatives' baseline characteristics between the control group and the intervention group ^a .

Characteristic	Total sample (n = 90)	Control (n = 47)	Intervention (n = 43)	p
Age (mean and SD)	48.64 (13.95)	48.5 (14.08)	48.57 (14.01)	0.8
Female, n (%)	125 (80.6%)	47 (77.0%)	43 (82.0%)	0.220
Single, divorced, widowed, n (%)	48 (47.5%)	28 (45.9%)	25 (33.8%)	0.622
Did not graduate from high school, n (%)	33 (33%)	17 (28.8%)	19 (32.6%)	0.249
Unemployed, n (%)	44 (46.3%)	27 (49.1%)	22 (43.1%)	0.293
Religious practice (yes), n (%)	83 (83%)	50 (82.0%)	39 (80.8%)	0.183
Mental health treatment, n (%)	20 (19.8%)	12 (24.5%)	8 (20.5%)	0.317

Note: Statistical analysis was performed using the two‐tailed Student's t‐test and the two‐tailed Fisher's exact test. p < 0.05 was considered a statistically significant result.

^a Continuous data are expressed as means ± standard deviation (SD). Percentage data refer to the total population of each group.

The relatives of the participants (Table 3), who were patients in the ICU, were admitted to this unit primarily due to acute respiratory failure (35%), with approximately 50% having confirmed cases of the novel Coronavirus (SARS‐CoV‐2) and septic shock (23%). No significant differences were identified in the causes of admission between the two groups. Furthermore, there was no evident distinction in treatments or procedures, such as prone ventilation, tracheostomy, or renal replacement therapy, which family members could readily observe. However, relatives in the interventional group experienced a longer duration of invasive mechanical ventilation, ICU stay, and hospitalisation.

TABLE 3.

Comparison of baseline and clinical characteristics of relatives in the ICU per group ^a .

Characteristic	Control group (n = 47)	Intervention group (n = 43)	p
Age (mean and SD)	56.7 (18.3)	57.9 (15.1)	0.9
Female, n (%)	27 (44%)	29 (42%)	0.8
COVID‐19, n (%)	7 (15.5%)	15 (22.1%)	0.1
APACHE II (mean and SD)	20.7 (10.5)	20.5 (8.2)	0.85
Prone position, n (%)	10 (16.3%)	8 (11.7%)	0.4
Tracheostomy, n (%)	16 (26.2%)	28 (41.1%)	0.07
RRT, n (%)	14 (22.9%)	12 (17.6%)	0.4
IMV days (mean and SD)	11 (6–22)	17 (8–41)	0.04
ICU LOS (mean and SD)	14 (8–25)	20 (11–43)	0.03
Hospital LOS (mean and SD)	34 (19–59)	52 (26–93)	0.01
Hospital mortality, n (%)	13 (21.3%)	12 (17.6%)	0.7

Abbreviations: APACHE II, Acute Physiology and Chronic Health Disease Classification System II; ICU, intensive care unit; IMV, invasive mechanical ventilation; LOS, length of stay; RRT, renal replacement therapy.

^a Continuous data are expressed as means ± standard deviation (SD). Percentage data refer to the total population of each group. Statistical analysis was performed using the two‐tailed Student's t‐test and the two‐tailed Fisher's exact test. p < 0.05 was considered a statistically significant result. Bold indicates significant values.

4.1.1. Psychological Test Results

The family members in the intervention group exhibited higher anxiety levels during the baseline evaluation. This finding was the only significant discrepancy noted in the baseline psychological tests (see Table 4). After the designated follow‐up period concluded, it was observed that 81.9% (50 relatives) of the control group and 75% (51 relatives) of the intervention group had completed it. At follow‐up, the intervention group showed a statistically significant reduction in PTSD symptoms, as measured by the IES‐R, compared to the pre‐intervention group (Mean ± SD: 38.2 ± 20.5 vs. 46.1 ± 15.2; p = 0.02), in the group that received the SC strategy compared to standard care. No significant between‐group differences were observed in HADS‐Anxiety or HADS‐Depression scores at follow‐up.

TABLE 4.

Change in anxiety, depression, and post‐traumatic stress disorder at 3 months compared to baseline per group ^a .

Psychological symptoms	Baseline assessment			3‐Months assessment
	Control (n = 47)	Intervention (n = 43)	p	Control (n = 47)	Intervention (n = 43)	p
Anxiety	11.9 (4.6)	13.5 (4.2)	0.039	10.9 (4.3)	10.4 (4.8)	0.573
Depression	8.2 (3.8)	8.7 (4.1)	0.52	7.70 (3.9)	6.8 (4.3)	0.284
PTSD	45.1 (15.3)	44.1 (15.1)	0.675	46.1 (15.2)	38.2 (20.5)	0.036

Abbreviation: PTSD, post‐traumatic stress disorder.

^a Continuous data are expressed as means ± standard deviation (SD). Percentage data refer to the total population of each group. Statistical analysis was performed using the two‐tailed Student's t‐test. p < 0.05 was considered a statistically significant result.

A stepwise logistic regression was performed to determine the effect of different variables on the final assessments. The initial step involved entering the socio‐demographic variables. This was followed by the subsequent entry of the following variables in consecutive order: receiving the intervention, practising a religion, and receiving mental health treatment. Finally, anxiety, depression, and post‐traumatic stress scores from the baseline assessment were included. The socio‐demographic variables encompassed sex, age, educational level, and marital status (with or without a partner).

In multivariable logistic regression models (Table 5), participation in the intervention was significantly associated with reduced odds of PTSD symptoms at follow‐up (OR = 0.067, 95% CI: 0.010–0.458, p < 0.05). Baseline PTSD scores were also a significant predictor (OR = 1.113, 95% CI: 1.046–1.185, p < 0.01). For anxiety and depression, only the baseline scores remained significant predictors (Anxiety: OR = 1.318, 95% CI: 1.106–1.572; Depression: OR = 1.335, 95% CI: 1.114–1.600).

TABLE 5.

Multivariable logistic regression models for anxiety, depression, and PTSD outcomes.

Characteristic	PTSD OR (95% CI)	Anxiety OR (95% CI)	Depression OR (95% CI)
Sex (female)	0.308 (0.034–2.796)	4.110 (0.846–19.983)	0.573 (0.077–4.241)
Age	1.002 (0.945–1.062)	1.011 (0.969–1.055)	1.041 (0.988–1.097)
Educational Level	0.685 (0.406–1.158)	0.776 (0.505–1.194)	0.835 (0.541–1.289)
Intervention	0,067 (0.010–0.458) a	0.616 (0.182–2.084)	1.214 (0.318–4.632)
Baseline score	1.113 (1.046–1.185) b	1.318 (1.106–1.572) b	1.335 (1.114–1.600) b

Abbreviations: CI, confidence interval; OR, odds ratio.

^a Each model was adjusted for age, sex, educational level, intervention, and baseline score.

^b Outcomes: Anxiety, depression, and PTSD measured at follow‐up (3 months after baseline).

4.2. Satisfaction With the Intervention

At the end of the 3‐month follow‐up, the intervention group reported significantly higher satisfaction levels. A brief satisfaction questionnaire was applied to 43 participants (93% response rate). Of these, 97% reported that the intervention helped them feel emotionally supported, 95% found the sessions meaningful and relevant to their needs, and 100% of respondents stated they would recommend the intervention to other families in similar situations. The full questionnaire items are included in Appendix S3.

5. Discussion

This study provides preliminary evidence that a brief generalist spiritual care (GSC) intervention may reduce the likelihood of probable PTSD among ICU family members. Among the three domains evaluated, PTSD, anxiety, and depression, only PTSD symptoms showed a statistically significant reduction, highlighting the potential of GSC to address trauma‐related stress. Our results indicate that receiving the intervention was associated with a lower likelihood of probable PTSD at the 3‐month follow‐up. However, no effect was found for anxiety or depression. These findings align with an increasing body of evidence highlighting the psychological impact of critical illness on patients' families and emphasizing the need for structured, family‐centred interventions to prevent PICS‐F [2, 34, 35, 36].

To our knowledge, this is the first study to assess a structured, GSC intervention as a preventive measure against PTSD in ICU family members. The intervention's impact on PTSD rather than anxiety or depression deserves special attention. PTSD symptoms often involve intrusive thoughts, hyperarousal, and avoidance, reactions that can directly result from witnessing a loved one's critical illness or death [37]. The intervention, based on the FICA model, focused on meaning‐making, personal values, and spiritual connection [38]. These elements are particularly well‐suited for trauma processing, fostering reflection, emotional expression, and a sense of transcendence. Conversely, symptoms of anxiety and depression may be influenced by broader biopsychosocial factors, such as pre‐existing mental health conditions, socioeconomic status, and the duration of caregiving stressors [31, 39, 40]. A brief spiritual intervention may not directly address these factors. In addition, as our study shows, baseline levels of anxiety were already high in this population, which is possible given their high vulnerabilities, previous diagnoses, and exposure to cumulative stress. This may have contributed to a ceiling effect, limiting the potential for improvement within the time frame and scope of this brief intervention.

Furthermore, although the intervention focused on the search for spiritual meaning and emotional expression, it did not specifically target cognitive distortions or patterns of sustained worry typical of anxiety and depression, which often require more structured psychological therapies. However, these findings should be interpreted with caution. The observed effect size may reflect an overestimation due to low power or sample variability, underscoring the preliminary nature of these results and the need for replication in larger, adequately powered studies.

Our findings underscore the complexity of addressing mental health outcomes among family members of ICU patients and suggest that multimodal or stepped‐care interventions may be necessary to reduce overall psychological distress effectively. It is also possible that the duration and intensity of the intervention, consisting of three virtual sessions, were insufficient to produce meaningful changes in symptoms of anxiety or depression. While spiritual support may offer immediate comfort or perspective, sustained psychological benefits may require more prolonged engagement, particularly in populations with pre‐existing vulnerabilities or chronic stress exposure. Future studies should explore the dose–response relationship and assess whether longer or combined interventions yield a greater impact on affective symptoms.

The innovative aspect of this approach lies in its emphasis on universal spiritual needs rather than specific religious traditions, making it applicable across religiously diverse settings. The virtual delivery format, introduced during pandemic visitation restrictions, proved highly effective. Unlike traditional spiritual care, which is often limited to in‐hospital pastoral services, usually faith‐based and chaplain‐led, this model offered meaningful support through trained volunteers operating remotely. It expanded access and maintained care continuity for families unable to be physically present. Its low logistical demands, flexibility, and impact highlight significant opportunities for spiritual support approaches in resource‐limited environments and upcoming hybrid care systems.

The high level of participant satisfaction with the intervention further supports its acceptability and perceived benefit. Participants reported feeling heard, understood, and supported, which are key factors in spiritual and emotional well‐being. These findings suggest that spiritual care can address deep existential concerns and enhance the psychological experience of ICU family members, even when provided outside the scope of a specific religious affiliation.

This study has several strengths. First, the intervention was carefully designed and systematically carried out. It relied on trained volunteers and used a validated tool (FICA) for spiritual assessment. The sample included a vulnerable population often underrepresented in psychosocial research. This group experienced high social vulnerability, low educational levels, and prior mental health diagnoses. Using validated tools, conducting follow‐ups at 3 months, and integrating the strategy into a public hospital setting increases its relevance and potential to expand. The intervention was conducted remotely, which was crucial because it did not require mobilizing participants and volunteers.

6. Limitations

This study has several limitations that warrant careful interpretation of the findings. First, the quasi‐experimental before‐and‐after design without randomisation precludes causal inference, and the observed effects should be interpreted as associations rather than causal relationships.

Although baseline demographic and most ICU treatment‐related characteristics were comparable between groups, relatives in the intervention group were exposed to patients with longer ICU stays, more days on mechanical ventilation, and prolonged hospitalisation, potential indicators of greater illness severity. These differences could have impacted the emotional experiences and psychological outcomes of family members, acting as potential clinical confounders. Furthermore, we did not formally assess family‐level psychosocial variables such as social support networks, caregiving burden, or access to external resources. Given the recognised vulnerability of families of critically ill patients, such unmeasured factors may have contributed to heterogeneity in outcomes and potentially moderated the intervention's impact.

The relatively small sample size may have reduced power to detect differences in secondary outcomes, leading to wide confidence intervals in regression analyses. While retention rates were acceptable in this real‐world setting, some participants did not complete follow‐up assessments, potentially introducing attrition bias. Given the non‐randomised design and the population's characteristics, those lost to follow‐up might differ systematically from those retained, potentially biasing the observed associations.

Additionally, outcomes were assessed using self‐report instruments, which may be subject to recall and social desirability bias. Finally, the study was conducted in a single public hospital in Chile. This may restrict how broadly the findings can be applied across different healthcare settings or cultural backgrounds.

Despite these limitations, the study offers preliminary evidence supporting the feasibility and potential benefits of a generalist spiritual care intervention for families of critically ill patients. These findings underscore the importance of future research. Wish should include multicentre randomised controlled trials with larger samples and longer follow‐up to assess the sustained effects of spiritual care interventions. In addition, exploring moderating variables such as religiosity, prior trauma, or baseline resilience may help tailor interventions to the needs of specific subgroups. Mixed‐methods approaches could also deepen understanding of the mechanisms by which spiritual care affects psychological outcomes.

7. Implications for Practice

Considering the strengths and limitations of our study, the findings have several implications for clinical practice and research. First, spiritual care provided by trained volunteers could be integrated into standard ICU support programs for families, particularly in settings where formal psychological or pastoral care is either inconsistently available or limited in scope. However, pastoral care is technically part of the usual care in our hospital. It is often restricted to daytime hours, reactive upon family request, and typically grounded in Catholic religious practice. In contrast, our intervention offered structured, proactive, and trans‐religious support, making it a valuable and potentially scalable complement to traditional approaches, especially in resource‐constrained or pluralist healthcare settings. The intervention's low cost, standardised structure, and feasibility via telehealth make it a promising tool for broader implementation. Although the intervention requires initial training and ongoing supervision, its reliance on trained non‐clinical volunteers and delivery via telehealth platforms allows for relatively low implementation costs—especially compared to interventions that require professional pastoral or psychological staff. Moreover, the model can be scaled through partnerships with academic institutions or community organisations. Future studies should assess the long‐term impact of such interventions, their effectiveness across diverse settings, and the potential role of baseline spiritual beliefs, resilience, or religiosity as moderators of intervention effects. A randomised controlled trial is necessary to confirm these preliminary findings and further investigate the mechanisms of action.

8. Conclusions

A structured, generalist spiritual care intervention delivered by volunteers was associated with reduced post‐traumatic stress disorder symptoms in family members of ICU patients 3 months after discharge. These results suggest that spiritual care could be a valuable, feasible, and acceptable tool for supporting the psychological well‐being of relatives of ICU patients. It should be included in comprehensive, family‐centred critical care strategies.

Funding

This study was supported by the Pontificia Universidad Católica de Chile (grant #105675/DPCC2020) and the Government of Chile's National Fund for Scientific and Technological Development (FONDECYT Regular #1241769). The funders had no role in the study design, data collection, analysis, interpretation, manuscript preparation, or the decision to submit this article for publication.

Ethics Statement

This study was approved by the Ethics Committee of the Faculty of Medicine of the Pontificia Universidad Católica de Chile (210111006) on August 5, 2021, and by the Ethics Committee of the Servicio de Salud Metropolitano Sur Oriente on October 21, 2021, which oversees research at the Complejo Asistencial Dr. Sótero del Río. All procedures were conducted in accordance with the Declaration of Helsinki and local ethical guidelines.

Consent

Written informed consent was obtained from all participants included in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix S1: Volunteer training and supervision materials—Overview of content and structure of the training workshops and supervision processes implemented throughout the intervention.

Appendix S2: Intervention manual—‘Spiritual Care and Accompaniment for Families of Hospitalised Patients: A Systematic, Periodic, and Telematic Volunteer‐Based Proposal’ 2024 Pontificia Universidad Católica de Chile. All rights reserved. This manual outlines the implementation strategy, training protocol, session structure, and guidance materials for volunteers.

Appendix S3: Satisfaction survey—Full questionnaire applied to relatives in the intervention group at 3‐month follow‐up, used to evaluate perceived usefulness, emotional support, and overall satisfaction.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.