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Introduction: Patient and family centered care (PFCC) is a foundational value of the Saskatchewan Health Authority. Since 2016, Regina ICUs have adopted an open family presence model and encouraged participation in multidisciplinary rounds. However, a prior study suggested that over half of patients and families felt uninvolved in key decisions. This study evaluated ICU stakeholders’ experiences with family rounds and PFCC to identify opportunities to improve structure, timing, and delivery of care. Methods: A qualitative study was conducted in the adult ICUs at Regina General and Pasqua Hospitals. Participants included patients admitted ≥48 hours, family members who attended ≥1 multidisciplinary round, and ICU healthcare providers (nurses, physicians, pharmacists, allied health). Exclusions were inability to provide informed consent and lack of English fluency without interpreter support. Purposive sampling was used. Semi-structured interviews (June 13–July 23, 2025) were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis (NVivo 15). Results: Nine participants: patients (n=2, 22%), family (n=3, 33%), healthcare providers (n=4, 44%). Median age was 44 years (IQR 35–62.5); 56% female. Patients’ median age was 58 (IQR 48–68), family 44 (IQR 41–71), providers 35 (IQR 30–47). Education: 4 doctoral, 2 undergraduate, 2 high school, 1 grade 10. Occupations included ICU physicians (n=3), pharmacist (n=1), and various non-clinical roles. Four themes emerged: (1) Communication gaps/role clarity (78%); (2) Emotional landscape/psychological strain (67%); (3) Inclusion and structure of rounds (56%); (4) Systemic/environmental challenges (56%). Patients stressed emotional vulnerability and reliance on nurses; families felt excluded and unaware of rounding practices; providers cited operational barriers to PFCC consistency. Conclusions: While PFCC was valued, gaps in clarity, communication, and inclusion were identified. Suggested co-designed interventions include standardized rounding checklists, plain language care summaries, and consistent scheduling/notification of rounds to promote transparency, enhance emotional support, and ensure consistent ICU communication processes.