# Cultural and socioeconomic determinants of family satisfaction with ICU care across the globe: a scoping review

## TL;DR

This review explores how cultural and socioeconomic factors affect family satisfaction with ICU care worldwide and highlights the need for more research in low- and middle-income countries.

## Contribution

The study provides a global overview of how cultural and socioeconomic factors influence family satisfaction in ICU care and identifies a research gap in low- and middle-income countries.

## Key findings

- Prioritizing patient symptoms and fostering communication improved family satisfaction.
- A major research gap exists in low- and middle-income countries.
- Tailored strategies are needed to address diverse cultural and socioeconomic factors in ICU care.

## Abstract

To map evidence on global cultural and socioeconomic determinants of family satisfaction with care in the intensive care unit (ICU), including assessment, the influence of cultural beliefs and practices, and the impact of socioeconomic status on family satisfaction.

This scoping review followed the Joanna Briggs Institute (JBI) guidelines and was reported in accordance with PRISMA-ScR. A comprehensive search of English-language studies was conducted across multiple databases. Studies were included if they examined the impact of cultural and socioeconomic factors on shared or end-of-life decision-making among family members, or if they explored the relationship between these factors and psychological outcomes (e.g., anxiety, depression, insomnia) in caregivers during ICU stays—provided that family satisfaction was also assessed. Two independent reviewers screened all studies, and data were extracted using a customized form to ensure consistency and relevance to the research question.

A total of 2,121 articles were identified from PubMed (n = 68), Scopus (n = 475), Embase (n = 1,436), Web of Science (n = 138), Cochrane (n = 4), and other sources (n = 10). After removing duplicates, 1,772 articles underwent title and abstract screening, with 101 full texts evaluated. Seventeen studies met the inclusion criteria. Data extraction focused on family characteristics (e.g., religion, race, education, kinship, prior ICU experience), sociocultural and economic factors, end-of-life practices, and ICU-related elements influencing family satisfaction. Findings were narratively synthesized to provide a comprehensive overview of these contextual influences. The review revealed that prioritizing patient symptoms, fostering effective communication to support shared decision-making, and showing compassion toward family needs significantly enhanced family satisfaction. However, a major gap was identified in research from low- and middle-income countries (LMICs). Further studies are needed to understand how diverse cultural and socioeconomic factors affect caregiver satisfaction in these settings and to develop tailored strategies that improve family experiences and outcomes in intensive care units globally.

This review comprehensively mapped the available evidence and noted that addressing the cultural, socioeconomic, religious, and spiritual needs of the family, including comfort-based care interventions in the ICU, may improve family perceptions of ICU care and satisfaction. Further studies are required, especially in LMIC settings, to address diverse races, religions, and ethnicities in this context.

https://osf.io/5xusk.