CHAPEL HILL, NC — Two years after Dr. David Y. Hwang and Dr. Alexander Presciutti received a Neurocritical Care Foundation grant to develop an emotional support intervention for caregivers of patients surviving ICU admission for coma, the results are in—and they’re promising.
The multisite pilot study of the Coma Family Program (COMA-F)–led by Drs. Hwang (Division Chief of UNC Neurocritical Care), Presciutti (Mass General Brigham), Melissa Motta (University of Maryland), and Ana-Maria Vranceanu (MGB)—demonstrated strong feasibility, acceptability, and preliminary effectiveness in reducing emotional distress among caregivers of patients with severe acute brain injury (SABI).
Addressing a Critical Gap in Care
Each year, thousands of Americans are admitted to intensive care units with SABI, often presenting in coma and requiring long-term life-sustaining treatments such as tracheostomy or gastrostomy. Their caregivers face prolonged uncertainty, ambiguous grief, and chronic emotional stress—yet few evidence-based psychosocial interventions exist to support them.
COMA-F was designed to fill this gap. Adapted from Dr. Vranceanu’s “Recovering Together” program, COMA-F is a six-session, mindfulness-based resilience intervention led by clinically psychologists and tailored specifically for caregivers of patients with SABI. Unlike its predecessor, COMA-F is not dyadic and focuses on managing caregiver burden and emotional distress rather than optimizing recovery.
Study Design and Outcomes
Between February 2024 and February 2025, the team conducted a single-arm open pilot trial across three geographically diverse sites: Massachusetts General Hospital, University of North Carolina School of Medicine, and University of Maryland School of Medicine.
Key findings include:
- Feasibility benchmarks exceeded: 73% of eligible caregivers consented to participate, and 88% completed the intervention.
- High satisfaction: 100% of caregivers who completed post-intervention surveys reported satisfaction with the program.
- Significant reductions in emotional distress: Participants showed large improvements in anxiety and depression scores, with average reductions of 7.3 points on the Hospital Anxiety and Depression Scale (HADS).
- Improved coping and mindfulness: Caregivers reported increased use of adaptive coping strategies and mindfulness skills, with large effect sizes.
Voices from the Study
Caregivers praised the program’s flexibility, relevance, and emotional support. One participant shared, “It was just like a gift. I found it really helpful and timely.” Others highlighted the value of learning to manage stress proactively: “Instead of flying off the handle, I was able to come back into myself and be a little bit more proactive.”
What’s Next
The pilot study’s success paves the way for a larger randomized controlled trial (RCT) to rigorously test COMA-F’s efficacy. The study team also plan to explore long-term outcomes and potential adaptations for caregivers who may prefer alternative formats or timing.
With its strong foundation and encouraging results, COMA-F potentially represents a meaningful step forward in addressing the unmet needs of caregivers navigating the challenges of severe brain injury.
