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Andersen SK, Herridge MS, Fiest KM. Recovery from Sepsis: Management beyond Acute Care. Semin Respir Crit Care Med 2024; 45:523-532. [PMID: 38968959 DOI: 10.1055/s-0044-1787993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Recovery from sepsis is a key global health issue, impacting 38 million sepsis survivors worldwide per year. Sepsis survivors face a wide range of physical, cognitive, and psychosocial sequelae. Readmissions to hospital following sepsis are an important driver of global healthcare utilization and cost. Family members of sepsis survivors also experience significant stressors related to their role as informal caregivers. Increasing recognition of the burdens of sepsis survivorship has led to the development of postsepsis recovery programs to better support survivors and their families, although optimal models of care remain uncertain. The goal of this article is to perform a narrative review of recovery from sepsis from the perspective of patients, families, and health systems.
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Affiliation(s)
- Sarah K Andersen
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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2
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Bryan AF, Reich AJ, Norton AC, Campbell ML, Schwartzstein RM, Cooper Z, White DB, Mitchell SL, Fehnel CR. Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU: Clinician Perceptions. CHEST CRITICAL CARE 2024; 2:100051. [PMID: 38957855 PMCID: PMC11218830 DOI: 10.1016/j.chstcc.2024.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV. RESEARCH QUESTION What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU? STUDY DESIGN AND METHODS This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole. RESULTS Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes. INTERPRETATION Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.
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Affiliation(s)
- Ava Ferguson Bryan
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Amanda J Reich
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Andrea C Norton
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Margaret L Campbell
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Richard M Schwartzstein
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Zara Cooper
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Douglas B White
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Susan L Mitchell
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Corey R Fehnel
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
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Beumeler LFE, Bethlehem C, Hoogstins-Vlagsma TT, van Zutphen T, Buter H, Navis GJ, Boerma EC. The prevalence of mental frailty in ICU survivors and informal caregiver strain: A 1-year retrospective study of the Frisian aftercare cohort. J Intensive Care Soc 2023; 24:356-363. [PMID: 37841292 PMCID: PMC10572478 DOI: 10.1177/17511437221139547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Intensive care unit (ICU) survivors often suffer from long-term mental problems and a reduced health-related quality of life (HRQoL). Symptoms of depression, anxiety, and post-traumatic stress disorder may render patients mentally frail post-ICU, resulting in impaired recovery and an increased informal caregiver burden. The aim of this study was to investigate the prevalence of mental frailty up to 12 months after ICU admission and pinpoint markers for early risk-assessment in clinical practice. Methods A retrospective cohort study (2012-2018) in which clinical and post-ICU data of long-stay (⩾48 h) ICU-patients was used. Mental frailty was identified as clinically relevant symptoms of depression, anxiety, or post-traumatic distress disorder at 12 months after discharge. Results The prevalence of mental frailty at 12 months post-ICU among the total group of 239 patients was 38%. Mental frailty was defined as clinically relevant symptoms of depression, anxiety, and/or trauma. To achieve this, previously validated cut off values were used for the HADS (HADS-Anxiety ⩾ 8; HADS-Depression ⩾ 8) and TSQ (⩾6), and CSI (⩾7). Conclusion A significant proportion of ICU-survivors can be identified as mentally frail, which is associated with impaired HRQoL at baseline and post-ICU, and high caregiver strain. These findings emphasize the need for integrative aftercare programs for both the patient and their informal caregivers.
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Affiliation(s)
- Lise F E Beumeler
- Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Carina Bethlehem
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | | | - Tim van Zutphen
- Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
- Faculty of Medical Sciences, University Medical Centre Groningen, The Netherlands
| | - Hanneke Buter
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Gerjan J Navis
- Faculty of Medical Sciences, University Medical Centre Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Azharuddin S, Vital-Daley K, Mustovic V, Marshall T, Calvin B, DuMont T, Swanson G, Barker B. Mental Health in Women. Crit Care Nurs Q 2023; 46:336-353. [PMID: 37684730 DOI: 10.1097/cnq.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Mental health illness has been increasing worldwide. The prevalence of mental illness and is higher among females than among males. It is estimated that one in 5 women experience a common mental health disorder. This article highlights gender disparities in the risk, prevalence, and presentation of different mental health disorders. Nearly all survivors of critical illness experience 1 or more domains of the post-intensive care syndrome. We review different mental health disorders including anxiety disorders, mood disorders, psychotic disorders, and post-intensive care syndrome, and medications used to manage these disorders. Delirium in the intensive care unit can be misdiagnosed as a primary psychiatric disorder and is important to distinguish from each other. We also highlight the inadequacy of surveillance and recognition of mental health disorders in the intensive care unit, leading to missed opportunities to properly manage these important psychiatric conditions.
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Affiliation(s)
- Syed Azharuddin
- Psychiatry and Behavioral Health Institute (Drs Vital-Daley, Mustovic, and Swanson), Division of Pulmonary and Critical Care Medicine (Drs Azharuddin, Marshall, DuMont, and Barker), and Division of Nursing, Allegheny General Hospital (Mr Calvin), Allegheny Health Network, Pittsburgh, Pennsylvania
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Vogel G, Joelsson-Alm E, Forinder U, Svensen C, Sandgren A. Shifting focus: A grounded theory of how family members to critically ill patients manage their situation. Intensive Crit Care Nurs 2023; 78:103478. [PMID: 37384978 DOI: 10.1016/j.iccn.2023.103478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Critical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home. RESEARCH METHODOLOGY/DESIGN We used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021. SETTING Three general intensive care units in Sweden, consisting of a university hospital and two county hospitals. FINDINGS The theory Shifting focus explains how family members' main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus. CONCLUSION Family members could stand in the shadow of the patients' critical illness and needs. This emotional adversity is processed through shifting focus from one's own needs and well-being to the patient's survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members' need for support and information, to reduce stress in everyday life, is needed. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.
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Affiliation(s)
- Gisela Vogel
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Ulla Forinder
- Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, SE-801 76 Gävle, Sweden.
| | - Christer Svensen
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, SE-352 52 Växjö, Sweden.
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Watland S, Solberg Nes L, Hanson E, Ekstedt M, Stenberg U, Børøsund E. The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study. JMIR Form Res 2023; 7:e46299. [PMID: 37097744 PMCID: PMC10170368 DOI: 10.2196/46299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. OBJECTIVE This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. METHODS The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). RESULTS The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. CONCLUSIONS This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.
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Affiliation(s)
- Solbjørg Watland
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Medicine Intensive Care Unit, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Ski, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Best A, Harvey C, Minton C. Experiences of families of prolonged critical illness survivors that are discharged home: An integrative review of the literature. Nurs Crit Care 2023. [DOI: 10.1111/nicc.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Amy Best
- School of Nursing Massey University Wellington New Zealand
- Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
| | - Clare Harvey
- School of Nursing Massey University Wellington New Zealand
| | - Claire Minton
- School of Nursing Massey University Palmerston North New Zealand
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Caregivers of Neuromuscular Patients Living with Tracheostomy during COVID-19 Pandemic: Their Experience. J Clin Med 2023; 12:jcm12020555. [PMID: 36675483 PMCID: PMC9862176 DOI: 10.3390/jcm12020555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Background: During a pandemic, tracheostomy management in neuromuscular disease (NMD) patients can be complex. Methods: Using a multicentre, multiple case study approach, we sought perspectives through semi-structured interviews via hybrid quali-quantitative analysis. The qualitative analysis involved a semi-structured interview and the quantitative analysis the completion of a battery of questionnaires. Aim: To investigate the caregivers’ experiences, burden and beliefs regarding tracheostomy during the Italian COVID-19 pandemic. The following instruments were administered: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS); Zarit Burden Interview (ZBI). Results: Fifty-three caregivers (62.3% female, mean age 52.2 (SD = 18.2)) participated in the study. The more resilient the carers, the more they were psychologically flexible (r = 0.380, p = 0.014) and able to cope adaptively with the emergency (r = 0.378, p < 0.006). Similarly, perceived control was higher the more resilient they were (r = 0.897, p < 0.001). The main emotions emerging were isolation and loneliness (15; 34.88%). The perception of tracheostomy meant that it could be seen as a lifesaver or as a condemnation. Similarly, the relationship with health professionals moves from satisfaction to a feeling of abandonment over the course of the pandemic. Conclusions: These findings offer a unique opportunity to understand the point of view of caregivers of NMD patients living with tracheotomy during the COVID-19 pandemic, when going to the hospital may have been hampered.
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Zhang J, Li Y, Gu Y, Fei Y, Yang G, Gu Y, Xu X. Status and influencing factors of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury: a quantitative and qualitative study. Acta Neurochir (Wien) 2022; 164:3119-3131. [PMID: 36241741 DOI: 10.1007/s00701-022-05385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/04/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Disease uncertainty widely exists among family caregivers of patients with moderate and severe craniocerebral injury. This negative emotional reaction will reduce the ability of family caregivers to make decisions during the critical stage of the patient, causing serious effects on the rescue and prognosis of patients with moderate and severe craniocerebral injury. Therefore, this article aims to understand the state of the uncertainty of the disease of family caregivers of patients with moderate and severe craniocerebral injury in China, to analyze the influencing factors, and to explore the specific resource of the uncertainty of the disease combined with qualitative study. The outcomes will provide a theoretical basis for formulating an accurate clinical nursing intervention strategy. METHODS This study was conducted in the neurosurgery ward. A total of 214 family caregivers were evaluated using five previously validated scales: (i) Mishel Uncertainty in Illness Scale for family member, (ii) Simplified Coping Style Questionnaire, (iii) Social Support Rating Scale, and (iv) Self-Rating Anxiety Scale, (v) Zarit Caregiver Burden Interview. Kolmogorov-Smirnov was used to test the normality of the data distribution. The potential determinants of disease uncertainty were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of disease uncertainty in family caregivers of patients with moderate and severe craniocerebral injury. Objective sampling method was used to conduct semi-structured interviews with 17 family caregivers of patients with moderate and severe craniocerebral injury, and Colaizzi 7-step analysis method was used to analyze and summarize the interview data. RESULTS The evaluated participants exhibited critically high levels of perceived uncertainty. The results of multiple linear regression showed that the influencing factors of family caregivers' disease uncertainty were anxiety, number of other caregivers, GOS, negative coping style, and caregiver burden. The qualitative research focuses on two main topics: the sources of disease uncertainty among family caregivers of patients with moderate and severe craniocerebral injury and experience to cope with the situation. CONCLUSION The main cause of disease uncertainty of family caregivers of patients with moderate and severe craniocerebral injury is that patients' disease progression and prognosis as well as caregivers' own pressure of responsibility and negative mental status. Furthermore, caregivers' own pressure of responsibility and negative mental status are not clear. Therefore, helping family caregivers adopt positive coping approaches, guiding them to actively seek support from family and society, improving their nursing skills, and understanding of disease progression and prognosis all play an important role in alleviating the uncertainty of the disease.
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Affiliation(s)
- Jiajia Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Yanqing Li
- Medical College of Nantong University, 19th Qixiu Road, Nantong, 226001, China.,Department of Nursing, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Yudan Gu
- Department of Stroke Center, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Yaya Fei
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Guiping Yang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Yan Gu
- Department of Surgery, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
| | - Xujuan Xu
- Medical College of Nantong University, 19th Qixiu Road, Nantong, 226001, China. .,Department of Nursing, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
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10
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Naaktgeboren R, Zegers M, Peters M, Akkermans R, Peters H, van den Boogaard M, van de Laar FA. The impact of an intensive care unit admission on the health status of relatives of intensive care survivors: A prospective cohort study in primary care. Eur J Gen Pract 2022; 28:48-55. [PMID: 35388714 PMCID: PMC9004533 DOI: 10.1080/13814788.2022.2057947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Relatives of intensive care unit (ICU) survivors may suffer from various symptoms after ICU admittance of their relative, known as post-intensive care syndrome-family (PICS-F). Studies regarding PICS-F have been performed but its impact in primary care is unknown. Objectives To explore health problems of relatives of ICU survivors in primary care. Methods This is an exploratory prospective cohort study in which we combined data from two hospitals and a primary care research network in the Netherlands. ICU survivors who had been admitted between January 2005 and July 2017 were identified and matched by sex and age with up to four chronically ill (e.g. COPD, cardiovascular disease) patients. In both groups, relatives living in the same household were identified and included in this study. Primary outcome was the number of new episodes of care (International Classification of Primary Care-2) for up to five years. Hazard ratios (HRs) for the total number of new episodes were calculated. Results Relatives of ICU survivors (n = 267, mean age 38.1 years, 41.0% male) had significantly more new care episodes compared to the reference group (n = 705, mean age 36.3 years, 41.1% male) 1–2 years (median 0.11 vs. 0.08, HR 1.26; 95% confidence interval (CI) 1.03–1.54) and 2–5 years (median 0.18 vs. 0.13, HR 1.28; 95%CI 1.06–1.56) after ICU discharge. No differences were found in the period before ICU admission. Conclusion Relatives of ICU survivors present more morbidity in primary care than relatives of chronically ill patients up to five years after ICU discharge.
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Affiliation(s)
- Rick Naaktgeboren
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Peters
- Department of Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Peters
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris A van de Laar
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Intérêt de l’évaluation pré-opératoire et prise en charge post opératoire du patient âgé. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2022. [DOI: 10.1016/j.banm.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Huang H, Dong H, Guan X, Zhang L, Zhou Q. The facilitated sensemaking model as a framework for nursing intervention on family members of mechanically ventilated patients in the intensive care unit. Worldviews Evid Based Nurs 2022; 19:467-476. [DOI: 10.1111/wvn.12606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Affiliation(s)
- HaiQun Huang
- School of Medicine and Nursing Sciences Huzhou University Huzhou China
- Guangzhou First People's Hospital Guangzhou China
| | - HaiYan Dong
- School of Medicine and Nursing Sciences Huzhou University Huzhou China
| | - XiaoYue Guan
- Department of Critical Care Huzhou Central Hospital Huzhou China
| | - Li Zhang
- Department of Critical Care Huzhou Central Hospital Huzhou China
| | - Qing Zhou
- Department of Critical Care Huzhou Central Hospital Huzhou China
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13
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Wong P, Gamble A, Jaspers R, Pope N, Endacott R. Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2048-2054. [DOI: 10.11124/jbies-21-00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Role Mismatch in Medical Decision-Making Participation Is Associated with Anxiety and Depression in Family Members of Patients in the Intensive Care Unit. J Trop Med 2022; 2022:8027422. [PMID: 35469334 PMCID: PMC9034962 DOI: 10.1155/2022/8027422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the mismatch between the preferred and actual roles in the medical decision-making of intensive care unit (ICU) patients' family members and the relationship between the role mismatch of family members' decisions and anxiety and depression syndromes. A total of 223 family members of ICU patients in the Affiliated Hospital of Jiangnan University in China were enrolled. The simple Chinese version of the Control Preference Scale was used to complete the surveys to assess the preferred and actual roles, and anxiety and depression syndromes were measured using the Generalized Anxiety Disorder-7 scale and Patient Health Questionnaire-9, respectively. For the preferred and actual roles, the active role rates were 16.1% and 8.1%, the cooperative role rates were 49.3% and 31.4%, and the passive role rates were 34.5% and 60.5%, respectively. The incidence of mismatch was 43.0% between the preferred and actual roles, and the consistency between their preferred and actual decision-making roles was poor (kappa = 0.309, P < 0.001). Family members with mismatched decision-making roles had significantly higher incidence rates of anxiety (90.6% vs. 57.5%, P < 0.001) and depression (86.5% vs. 63.0%, P < 0.001). Logistic regression analysis revealed that mismatches in decision-making roles remained independently associated with these outcomes after adjustment for family members' sociodemographic features. The results of the present study demonstrate that the preferred role of ICU patients' family members is mainly cooperative, and the actual role is mainly passive. The mismatch between the preferred and actual roles is associated with anxiety and depression among the ICU patients' family members.
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15
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Kosovali BD, Tezcan B, Aytaç I, Tuncer Peker T, Soyal OB, Mutlu NM. Anxiety and Depression in the Relatives of COVID-19 and Non-COVID-19 Intensive Care Patients During the Pandemic. Cureus 2021; 13:e20559. [PMID: 35103138 PMCID: PMC8771297 DOI: 10.7759/cureus.20559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background and aim In the literature, there is no study on the anxiety and depression status of the relatives of intensive care COVID-19 and non-COVID-19 patients during the pandemic period. In this study, we aimed to compare the risk of developing anxiety and depression in the relatives of COVID-19 and non-COVID-19 intensive care patients during the pandemic, and also to determine the factors that may cause anxiety and depression. Materials and methods Relatives of patients admitted to Ankara City Hospital COVID-19 (n=45) and non-COVID-19 (n=45) intensive care units between 15 May and 31 July 2021 were included in this prospective study. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to the relatives of the patients within the first 48 hours of their admission to the intensive care unit. The answers were recorded and HADS, HADS-A (anxiety) and HADS-D (depression) scores were calculated accordingly. Demographics, education and marital statuses of both the patients and their relatives were recorded. Logistic regression analysis was performed to determine the factors associated with depression and anxiety. Receiver operator characteristics (ROC) curves were drawn for the factors affecting depression and anxiety, and the area under the curve values were calculated. Results Demographics, APACHE II score, and patient affiliation were similar in both groups. The mean HADS scores of the relatives of COVID-19 and non-COVID-19 patients were 24.76 and 16.04 (p<0.001). The mean HADS-A scores were 12.89 and 7.78 (p<0.001), and the mean of HADS-D scores were 11.87 and 8.27 (p=0.001). Moderate and high-risk anxiety and depression were significantly higher in relatives of COVID-19 patients (p=0.018, p=0.001, respectively). The area under curve (AUC) values were 0.727 in the ROC curve plotted for the independent risk factor Q3 responses that reduced anxiety, and 0.791 and 0.785 in the ROC curve drawn for the independent risk factor Q1 and Q3 responses that reduced the development of depression. Conclusion We found that the anxiety and depression risk of the relatives of COVID-19 patients in the intensive care unit during the pandemic period is significantly higher than the relatives of non-COVID-19 patients in the intensive care unit. In addition, regardless of the diagnosis, younger intensive care patients may increase the anxiety and depression of the relatives of the patients during the pandemic. The higher-education level of the relatives of patients was determined as a factor reducing anxiety and depression.
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Affiliation(s)
- Behiye Deniz Kosovali
- Department of Critical Care Medicine, Health of Science Ankara City Hospital, Ankara, TUR
| | - Busra Tezcan
- Department of Critical Care Medicine, Health of Science Ankara City Hospital, Ankara, TUR
| | - Ismail Aytaç
- Department of Anesthesiology and Reanimation, Health of Science Ankara City Hospial, Ankara, TUR
| | - Tulay Tuncer Peker
- Department of Critical Care Medicine, Gulhane Education and Research Hospital, Ankara, TUR
| | - Ozlem B Soyal
- Department of Anesthesiology and Reanimation, Health of Science Ankara City Hospital, Ankara, TUR
| | - Nevzat Mehmet Mutlu
- Department of Critical Care Medicine, Health of Science Ankara City Hospital, Ankara, TUR
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16
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Kosovali BD, Mutlu NM, Gonen CC, Peker TT, Yavuz A, Soyal OB, Cakır E, Akan B, Gokcinar D, Erdem D, Turan IO. Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic? Int J Clin Pract 2021; 75:e14328. [PMID: 33960085 PMCID: PMC8236937 DOI: 10.1111/ijcp.14328] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.
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Affiliation(s)
| | | | - Canan Cam Gonen
- Department of Critical Care UnitAnkara City HospitalAnkaraTurkey
| | | | - Asiye Yavuz
- Department of Critical Care UnitAnkara City HospitalAnkaraTurkey
| | - Ozlem Balkiz Soyal
- Department of Anesthesiology and ReanimationAnkara City HospitalAnkaraTurkey
| | - Esra Cakır
- Department of Critical Care UnitAnkara City HospitalAnkaraTurkey
| | - Belgin Akan
- Department of Critical Care UnitAnkara City HospitalAnkaraTurkey
| | - Derya Gokcinar
- Department of Critical Care UnitAnkara City HospitalAnkaraTurkey
| | - Deniz Erdem
- Department of Critical Care UnitAnkara City HospitalAnkaraTurkey
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Herling SF, Egerod I, Bove DG, Møller K, Larsen LK, Oxenbøll Collet M, Zegers M, van den Boogaard M, Thomsen T. Cognitive training for prevention of cognitive impairment in adult intensive care unit (ICU) patients. Hippokratia 2021. [DOI: 10.1002/14651858.cd014630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Suzanne Forsyth Herling
- Department of Clinical Medicine, Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
- The Neuroscience Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - Ingrid Egerod
- Department of Clinical Medicine, Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
- Department of Intensive Care; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Dorthe G Bove
- Emergency Department; Nordsjaellands University Hospital; Hillerød Denmark
| | - Kirsten Møller
- Neuroanaesthesiology - The Neuroscience Centre; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences, University of Copenhagen; Copenhagen Denmark
| | - Laura Krone Larsen
- Department of Neuroanaesthesiology; Rigshospitalet, University Hospital of Copenhagen; Copenhagen Denmark
| | - Marie Oxenbøll Collet
- Department of Intensive Care; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Marieke Zegers
- Intensive Care Medicine; Radboud University Medical Center; Nijmegen Netherlands
| | | | - Thordis Thomsen
- Department of Clinical Medicine, Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
- Herlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of Anesthesiology; Copenhagen University Hospital Herlev-Gentofte; Copenhagen Denmark
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18
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Glimelius Petersson C, Jakobsson L, Westergren A, Bergbom I. Factors and health-related quality of life associated with participation in a post-ICU follow-up. A register study. Acta Anaesthesiol Scand 2021; 65:902-911. [PMID: 33650105 DOI: 10.1111/aas.13811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/09/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Follow-up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse-led clinic (NLC) at different time-points, and to describe physical and mental health (HRQoL) over time. METHODS Patients with a length of stay (LOS) of ≥72 hours, discharged from a general intensive care unit 2004-2014, who participated in a 6-month follow-up programme offering visits to NLC at 2 and 6 months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on 2-, 6- and 12-month HRQoL by using SF-36 from the Swedish Intensive Care Registry. RESULTS Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P = .000), had lower Simplified Acute Physiology scores (P = .001) and higher SF-36 physical health domain scores at 2 months (P < .05) compared to those not visiting at all. Visitors at 2 months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at 6 months only. Patients visiting the NLC scored significantly higher in all domains from 2 to 12 months, whereas non-visiting-patients' did this in four out of eight domains during the same time frame. CONCLUSION Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to the development of existing routines to match the diversity of patients' needs and life situations.
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Affiliation(s)
| | | | - Albert Westergren
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
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19
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Peritraumatic Stress among Caregivers of Patients in the Intensive Care Unit. Ann Am Thorac Soc 2021; 17:650-654. [PMID: 32068429 DOI: 10.1513/annalsats.201908-647rl] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Yeshokumar AK, Blum RA, Randell T, Jetté N, Easton A. Exploration of patient- and relative-reported outcomes of cognitive, emotional, and social function after encephalitis. Brain Inj 2020; 35:255-263. [PMID: 33356613 DOI: 10.1080/02699052.2020.1865567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: We evaluated cognitive, emotional, and social function after encephalitis, as perceived and reported by individuals post-encephalitis and their relatives.Hypothesis: There will be differential effects on various domains as self-reported by individuals post-encephalitis. Outcomes will be worse than in prior studies of other forms of acute brain injury. Post-encephalitis relative-report will demonstrate worse outcomes than self-report.Methods and Procedures: Members of The Encephalitis Society residing in the United Kingdom and Ireland were recruited to complete a demographic questionnaire and the European Brain Injury Questionnaire (EBIQ).Results: 266 individuals affected by encephalitis and 140 relatives participated in this study. The three domains with the highest (worst) mean scores were somatic, cognitive, and communication (p < .001). Individuals post-encephalitis self-reported worse outcomes than individuals post-stroke in seven of nine domains (p < .005), but there were no differences compared to individuals post-traumatic brain injury (TBI). Relatives reported worse encephalitis outcomes in seven of nine domains than did individuals directly affected by encephalitis (p < .005).Conclusions: Individuals affected by encephalitis experience the most significant symptoms in the somatic, cognitive, and communication domains. Outcomes as assessed by relatives were notably worse than those assessed by individuals themselves in nearly all domains.
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Affiliation(s)
- Anusha K Yeshokumar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raia A Blum
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Taylor Randell
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ava Easton
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,The Encephalitis Society, Malton, UK
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21
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Wong P, Redley B, Bucknall T. Families' control preference for participation in patient care in adult intensive care. Intensive Crit Care Nurs 2020; 62:102953. [PMID: 33189518 DOI: 10.1016/j.iccn.2020.102953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Understand families' preferences and observed participation in patient care in an adult ICU. RESEARCH METHODOLOGY The mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients. SETTING Two public hospital intensive care units in Australia. MAIN OUTCOME MEASURES 1) Families' preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit. RESULTS Almost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%). CONCLUSION Differences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.
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Affiliation(s)
- Pauline Wong
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
| | - Bernice Redley
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Tracey Bucknall
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, The Alfred, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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22
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Yuan C, Timmins F, Thompson DR. Post-intensive care syndrome: A concept analysis. Int J Nurs Stud 2020; 114:103814. [PMID: 33220570 DOI: 10.1016/j.ijnurstu.2020.103814] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Post-intensive care syndrome is a term used to describe new or worsening multidimensional impairments in physical, psychological cognitive and social status arising from critical illness and persisting beyond hospital discharge. It is associated with high morbidity among patients discharged from intensive care units. However, due to its complexities, which encompass physical, psychological, cognitive and social impairments, the exact nature of this condition has not been fully conceptualized. The aim of this analysis therefore was to define the concept of post-intensive care syndrome. This conceptual clarity provides a general definition that is essential for practitioners and researchers to gain a comprehensive understanding of the syndrome and provide for accurate measurement of its incidence and prevalence. DESIGN The Walker and Avant approach to concept analysis guided this investigation. DATA SOURCE An electronic search of the literature using PubMed, CINHAL, PsycArticles, Academic search complete, Science Direct, MEDLINE and Health Source databases informed the analysis. The search included both quantitative and qualitative studies related to post-intensive care syndrome published in English between 2010 and 2020. RESULTS Of the 3948 articles identified, 24 ultimately met the inclusion criteria. Analysis identified the defining attributes of post-intensive care syndrome as: (1) new or worsening multidimensional impairments; (2) physical dysfunction; (3) psychological disorder; (4) cognitive impairment; (5) failed social reconstruction; and (6) persistent impaired multidimensional symptoms extending beyond intensive care and hospital discharge. Antecedents were divided into two categories: pre-existing and those related to the intensive care admission. Consequences were identified as both positive (for example the establishment of coping processes) and adverse (for example decreased quality of life and caregiver burden). CONCLUSION Post-intensive care syndrome affects more than half of patients discharged from intensive care units. This operational definition and conceptual understanding of this syndrome will help improve understanding and inform the design of preventative strategies to improve long-term consequences of the syndrome. Future research and standardized instrument development will serve to better understand the scope and characteristics of this syndrome and inform the development of possible preventative interventions.
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Affiliation(s)
- Chu Yuan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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23
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Saeid Y, Salaree MM, Ebadi A, Moradian ST. Family Intensive Care Unit Syndrome: An Integrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:361-368. [PMID: 33344205 PMCID: PMC7737832 DOI: 10.4103/ijnmr.ijnmr_243_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors. MATERIALS AND METHODS The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005-2018 with the keywords "FICUS," "intensive care unit," "family," "caregivers," "anxiety," "depression," and "post-traumatic stress disorder" in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study. RESULTS Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS. CONCLUSIONS On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term "FICUS" in the research literature. Thus, further research is needed to explore FICUS in the health field.
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Affiliation(s)
- Yaser Saeid
- Students Research Committee and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Salaree
- Health Research Center. Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Petersen JJ, Østergaard B, Svavarsdóttir EK, Rosenstock SJ, Brødsgaard A. A challenging journey: The experience of elderly patients and their close family members after major emergency abdominal surgery. Scand J Caring Sci 2020; 35:901-910. [PMID: 32857474 DOI: 10.1111/scs.12907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/19/2020] [Accepted: 08/02/2020] [Indexed: 12/16/2022]
Abstract
RATIONALE Knowledge of how elderly patients undergoing major emergency abdominal surgery and their close family members experience the course of illness is limited. Little is known about how such surgery and hospitalisation affect elderly patients' daily life after discharge. It is well known that such patients have an increased risk of mortality and that their physical functional level often decreases during hospitalisation, which can make them dependent on family or homecare services. Critical illness and caregiving for a close relative can be a stressful experience for families, which are at risk of developing stress-related symptoms. AIM To explore how elderly patients and their families experience the course of illness during hospitalisation and the first month at home after discharge. METHOD A phenomenological study was conducted to gain in-depth descriptions through 15 family interviews with 15 patients who had undergone major emergency abdominal surgery and 20 of their close adult family members. Data were analysed using a phenomenological approach inspired by Giorgi. FINDINGS The essence of the phenomenon is captured in three themes: (1) Being emotionally overwhelmed, (2) Wanting to be cared for and (3) Finding a way back to life. CONCLUSION Patients and their close family members experienced the course of illness as a challenging journey where they longed for life to become as it was before illness. They experienced illness as a sudden life-threatening incidence. In this situation, it was crucial to be met with empathy from healthcare professionals. The patients' experience of fatigue and powerlessness remained intense one month after discharge and affected their and their close family members' lives.
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Affiliation(s)
- Julie Jacoby Petersen
- Gastrounit, Surgical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Graduate School of Health, University of Aarhus Graduate School of Health Sciences, Aarhus N, Denmark
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Steffen Jais Rosenstock
- Gastrounit, Surgical Division, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Denmark.,Section for Nursing, Department of Public Health, University of Aarhus, Aarhus, Denmark
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Kohler J, Borchers F, Endres M, Weiss B, Spies C, Emmrich JV. Cognitive Deficits Following Intensive Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:627-634. [PMID: 31617485 DOI: 10.3238/arztebl.2019.0627] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/06/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Illnesses that necessitate intensive care can impair cognitive function severely over the long term, leaving patients less able to cope with the demands of everyday living and markedly lowering their quality of life. There has not yet been any comprehensive study of the cognitive sequelae of critical illness among non- surgical patients treated in intensive care. The purpose of this review is to present the available study findings on cognitive deficits in such patients, with particular at- tention to prevalence, types of deficit, clinical course, risk factors, prevention, and treatment. METHODS This review is based on pertinent publications retrieved by a selective search in MEDLINE. RESULTS The literature search yielded 3360 hits, among which there were 14 studies that met our inclusion criteria. 17-78% of patients had cognitive deficits after dis- charge from the intensive care unit; most had never had a cognitive deficit before. Cognitive impairment often persisted for up to several years after discharge (0.5 to 9 years) and tended to improve over time. The only definite risk factor is delirium. CONCLUSION Cognitive dysfunction is a common sequela of the treatment of non-surgical patients in intensive care units. It is a serious problem for the affected persons and an increasingly important socio-economic problem as well. The effective management of delirium is very important. General conclusions are hard to draw from the available data because of heterogeneous study designs, varying methods of measurement, and differences among patient cohorts. Further studies are needed so that study designs and clinical testing procedures can be standard- ized and effective measures for prevention and treatment can be identified.
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Affiliation(s)
- Joel Kohler
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin; Department of Anesthesiology and Operative Intensive Care Medicine at Campus Benjamin Franklin Charité-Universitätsmedizin Berlin
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26
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Wong P, Redley B, Digby R, Correya A, Bucknall T. Families’ perspectives of participation in patient care in an adult intensive care unit: A qualitative study. Aust Crit Care 2020; 33:317-325. [DOI: 10.1016/j.aucc.2019.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
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Kang J, Cho YJ, Choi S. State anxiety, uncertainty in illness, and needs of family members of critically ill patients and their experiences with family-centered multidisciplinary rounds: A mixed model study. PLoS One 2020; 15:e0234296. [PMID: 32516349 PMCID: PMC7282650 DOI: 10.1371/journal.pone.0234296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to determine whether family-centered multidisciplinary rounds could alleviate anxiety and uncertainty in illness and meet needs for critically ill patients’ families. A family-centered multidisciplinary rounds protocol was developed identifying needs of critically ill patients’ families, and family experiences were reviewed through in-depth interviews. A sequential mixed-methods study was utilized, combining survey data and semi-structured interviews in a tertiary medical intensive care unit in South Korea. A structured questionnaire assessed needs, anxiety, and uncertainty in illness for 50 participants. Interview data of 10 participants were analyzed using grounded theory. Assurance was the highest family need, followed by information need. Family needs differed according to gender, relationship to the patient, and length of intensive care unit stay. Participants reported family-centered multidisciplinary rounds provided a sense of relief, a chance to listen to medical staff, and a chance to provide medical staff with comprehensive information about patient care. Proximity needs were found to have a positive correlation with state anxiety, while comfort needs had a negative correlation with uncertainty in illness. Families reported family-centered multidisciplinary rounds were positive, useful experiences. Thus, standardization of family-centered multidisciplinary rounds is needed to meet families’ various needs.
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Affiliation(s)
- Jiyeon Kang
- Department of Anthropology, University of Virginia, Charlottesville, VA, United States of America
| | - Young-Jae Cho
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - Seunghye Choi
- College of Nursing, Gachon University, Yeonsu-gu, Incheon, Korea
- * E-mail:
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Murray H, Grey N, Wild J, Warnock-Parkes E, Kerr A, Clark DM, Ehlers A. Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e13. [PMID: 34191936 PMCID: PMC7251252 DOI: 10.1017/s1754470x2000015x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have been published for delivering trauma-focused cognitive behavioural therapy with this population. In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU. KEY LEARNING AIMS To recognise PTSD following admissions to intensive care units (ICUs).To understand how the ICU experience can lead to PTSD development.To understand how Ehlers and Clark's (2000) cognitive model of PTSD can be applied to post-ICU PTSD.To be able to apply cognitive therapy for PTSD to patients with post-ICU PTSD.
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Affiliation(s)
- Hannah Murray
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, UK
- University of Sussex, UK
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Emma Warnock-Parkes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- King's College London, London, UK
| | | | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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29
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Smith JM, Lee AC, Zeleznik H, Coffey Scott JP, Fatima A, Needham DM, Ohtake PJ. Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome. Phys Ther 2020; 100:1062-1073. [PMID: 32280993 PMCID: PMC7188154 DOI: 10.1093/ptj/pzaa059] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/26/2022]
Abstract
More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.
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Affiliation(s)
- James M Smith
- Physical Therapy Department, Utica College, 1600 Burrstone Road, Utica, NY 13502 (USA),Address all correspondence to Dr Smith at:
| | - Alan C Lee
- Department of Physical Therapy, Mount St Mary’s University, Los Angeles, California
| | - Hallie Zeleznik
- Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Arooj Fatima
- Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dale M Needham
- Pulmonary & Critical Care Medicine and Physical Medicine & Rehabilitation, Johns Hopkins University
| | - Patricia J Ohtake
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York
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30
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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31
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Return to Employment after Critical Illness and Its Association with Psychosocial Outcomes. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 16:1304-1311. [DOI: 10.1513/annalsats.201903-248oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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32
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Early Risk and Resiliency Factors Predict Chronic Posttraumatic Stress Disorder in Caregivers of Patients Admitted to a Neuroscience ICU. Crit Care Med 2019; 46:713-719. [PMID: 29384786 DOI: 10.1097/ccm.0000000000002988] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Informal caregivers-that is, close family and friends providing unpaid emotional or instrumental care-of patients admitted to ICUs are at risk for posttraumatic stress disorder. As a first step toward developing interventions to prevent posttraumatic stress disorder in ICU caregivers, we examined the predictive validity of psychosocial risk screening during admission for caregiver posttraumatic stress disorder at 3 and 6 months post hospitalization. DESIGN An observational, prospective study. PARTICIPANTS Ninety-nine caregivers were recruited as part of a longitudinal research program of patient-caregiver dyads in a neuroscience ICU. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Caregiver posttraumatic stress disorder symptoms were assessed during admission (baseline), 3 months, and 6 months post hospitalization. We 1) characterized prevalence of clinically significant symptoms at each time point 2); calculated sensitivity and specificity of baseline posttraumatic stress disorder screening in predicting posttraumatic stress disorder at 3 and 6 months; and 3) used recursive partitioning to select potential baseline factors and examine the extent to which they helped predict clinically significant posttraumatic stress disorder symptoms at each time point. Rates of caregiver posttraumatic stress disorder remained relatively stable over time (16-22%). Screening for posttraumatic stress disorder at baseline predicted posttraumatic stress disorder at 3 and 6 months with moderate sensitivity (75-80%) and high specificity (92-95%). Screening for posttraumatic stress disorder at baseline was associated with caregiver anxiety, mindfulness (i.e., ability to be aware of one's thoughts and feelings in the moment), and bond with patient. Furthermore, baseline posttraumatic stress disorder screening was the single most relevant predictor of posttraumatic stress disorder at 3 and 6 months, such that other baseline factors did not significantly improve predictive ability. CONCLUSIONS Screening neuroscience ICU caregivers for clinically significant posttraumatic stress disorder symptoms during admission is the single most important way to identify the majority of those likely to suffer from chronic posttraumatic stress disorder following discharge. Addressing early posttraumatic stress disorder symptoms and their psychosocial correlates during admission may help prevent chronic posttraumatic stress disorder in these at-risk caregivers.
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33
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Affiliation(s)
- Ruth Spence
- Centre for Abuse and Trauma Studies,Psychology Department,Middlesex University,London,UK
| | - Lisa Kagan
- Centre for Abuse and Trauma Studies,Psychology Department,Middlesex University,London,UK
| | - Antonia Bifulco
- Centre for Abuse and Trauma Studies,Psychology Department,Middlesex University,London,UK
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Kelmenson DA, Neumeier A, Badlam JB, Eickelberg O. Recovery from Critical Illness: Physical Rehabilitation in the Intensive Care Unit, Timing of Persistent Critical Illness, and Caregiver Outcomes. Am J Respir Crit Care Med 2019; 196:1068-1070. [PMID: 28841330 DOI: 10.1164/rccm.201704-0828rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel A Kelmenson
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Anna Neumeier
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica B Badlam
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Oliver Eickelberg
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
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35
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Stayt LC, Venes TJ. Outcomes and experiences of relatives of patients discharged home after critical illness: a systematic integrative review. Nurs Crit Care 2018; 24:162-175. [PMID: 30560592 DOI: 10.1111/nicc.12403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/27/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients discharged from intensive care may experience psychological and physical deficits resulting in a long and complex rehabilitation upon discharge. Relatives are also vulnerable to psychological pathologies and diminished health-related quality of life following the patients' critical illness. Relatives often provide care during the patients' rehabilitation, which may influence their health. AIM To report the outcomes and experiences of relatives of patients discharged home after critical illness. DESIGN Systematic integrative review. METHODS Electronic databases Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase®, and PsychINFO® were searched using keywords, synonyms, and medical subject headings. Reference lists of articles and critical care journals were manually searched. Studies eligible for inclusion reported primary research and were published in English between 2007 and 2017. Studies were appraised using the Critical Appraisal Skills Programme checklists. Data were extracted and then analysed according to framework. FINDINGS Twenty-five studies were included: 19 quantitative, 4 qualitative, and 1 mixed method study. Three themes were identified: health and well-being, employment and lifestyle, and caregiving role. Health and well-being reports the incidence and significance of psychological morbidity such as post-traumatic stress disorder, anxiety, and depression. Employment and lifestyle describes the impact of caregiving on the relative's ability to work and engage in usual social activities. The final theme describes and discusses the caregiving role in terms of activities of daily living, knowledge and skills, and adaption to the role. CONCLUSIONS There is a significant and meaningful impact on outcomes and experiences of relatives of patients discharged home after critical illness. Relatives' caregiving is embedded within the context of their psychological morbidity and social adjustment. RELEVANCE TO PRACTICE If informal care giving is to be sustainable, there is a need to design effective strategies of supporting families through all stages of the critical illness trajectory.
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Affiliation(s)
- Louise C Stayt
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
| | - Trevor J Venes
- Adult Intensive Care, Oxford University Hospital Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Guidet B, Vallet H, Boddaert J, de Lange DW, Morandi A, Leblanc G, Artigas A, Flaatten H. Caring for the critically ill patients over 80: a narrative review. Ann Intensive Care 2018; 8:114. [PMID: 30478708 PMCID: PMC6261095 DOI: 10.1186/s13613-018-0458-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/14/2018] [Indexed: 12/25/2022] Open
Abstract
Background There is currently no international recommendation for the admission or treatment of the critically ill older patients over 80 years of age in the intensive care unit (ICU), and there is no valid prognostic severity score that includes specific geriatric assessments. Main body In this review, we report recent literature focusing on older critically ill patients in order to help physicians in the multiple-step decision-making process. It is unclear under what conditions older patients may benefit from ICU admission. Consequently, there is a wide variation in triage practices, treatment intensity levels, end-of-life practices, discharge practices and frequency of geriatrician’s involvement among institutions and clinicians. In this review, we discuss important steps in caring for critically ill older patients, from the triage to long-term outcome, with a focus on specific conditions in the very old patients. Conclusion According to previous considerations, we provide an algorithm presented as a guide to aid in the decision-making process for the caring of the critically ill older patients. Electronic supplementary material The online version of this article (10.1186/s13613-018-0458-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bertrand Guidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Réanimation Médicale, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. .,Sorbonne Universités, Université Pierre et Marie Curie - Paris 06, Paris, France. .,INSERM, UMR_S 1136, Institute Pierre Louis d'Épidémiologie et de Santé Publique, 75013, Paris, France.
| | - Helene Vallet
- INSERM, UMR_S 1136, Institute Pierre Louis d'Épidémiologie et de Santé Publique, 75013, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Service de gériatrie, Hôpital Pitié salpêtrière, 75013, Paris, France
| | - Jacques Boddaert
- Sorbonne Universités, Université Pierre et Marie Curie - Paris 06, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Service de gériatrie, Hôpital Pitié salpêtrière, 75013, Paris, France
| | - Dylan W de Lange
- Department of Intensive Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Alessandro Morandi
- Department of Rehabilitation Hospital Ancelle di Cremona, Cremona, Italy.,Geriatric Research Group, Brescia, Italy
| | - Guillaume Leblanc
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada
| | - Antonio Artigas
- Department of Intensive Care Medecine, CIBER EnfermedadesRespiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Dzeng E, Curtis JR. Understanding ethical climate, moral distress, and burnout: a novel tool and a conceptual framework. BMJ Qual Saf 2018; 27:766-770. [PMID: 29669857 PMCID: PMC6540991 DOI: 10.1136/bmjqs-2018-007905] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Elizabeth Dzeng
- University of California, San Francisco, Department of Medicine, Division of Hospital Medicine; San Francisco, California, USA
- University of California, San Francisco, Department of Social and Behavioral Science, Sociology Program; San Francisco, California, USA
| | - J. Randall Curtis
- University of Washington, Cambia Palliative Care Center of Excellence, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine; Seattle, Washington, USA
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Choi J, Lingler JH, Donahoe MP, Happ MB, Hoffman LA, Tate JA. Home discharge following critical illness: A qualitative analysis of family caregiver experience. Heart Lung 2018; 47:401-407. [PMID: 29731146 PMCID: PMC6026552 DOI: 10.1016/j.hrtlng.2018.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have longitudinally explored the experience and needs of family caregivers of ICU survivors after patients' home discharge. METHODS Qualitative content analysis of interviews drawn from a parent study that followed family caregivers of adults ICU survivors for 4 months post-ICU discharge. RESULTS Family caregivers (n = 20, all white, 80% woman) viewed home discharge as positive progress, but reported having insufficient time to transition from family visitor to the active caregiver role. Caregivers expressed feelings of relief during the steady recovery of family members' physical and cognitive function. However, the slow pace of improvement conflicted with their expectations. Even after patients achieved independent physical function, emotional needs persisted and these issues contributed to caregivers' anxiety, worry, and view that recovery was incomplete. CONCLUSION Family caregivers of ICU survivors need information and skills to help managing patients' care needs, pacing expectations with actual patients' progress, and caregivers' health needs.
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Affiliation(s)
- JiYeon Choi
- Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA; Yonsei University College of Nursing, Seoul, Republic of Korea.
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburg, School of Nursing, Pittsburgh, PA, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Happ
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Leslie A Hoffman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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Zale EL, Heinhuis TJ, Tehan T, Salgueiro D, Rosand J, Vranceanu AM. Resiliency is independently associated with greater quality of life among informal caregivers to neuroscience intensive care unit patients. Gen Hosp Psychiatry 2018; 52:27-33. [PMID: 29549820 DOI: 10.1016/j.genhosppsych.2018.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Every year, millions of Americans become informal caregivers to loved ones admitted to Neuroscience Intensive Care Units (Neuro-ICU), and face challenges to Quality of Life (QoL). This study sought to identify associations between resiliency, distress, and caregiver QoL at time of Neuro-ICU admission. METHODS Informal caregivers (N = 79, Mage = 53, 64% female) of Neuro-ICU patients were recruited and completed self-report questionnaires during the hospitalization. We used hierarchical regression to test relative contributions of caregiver mindfulness, perceived coping abilities, and preparedness for caregiving to caregiver QoL, above-and-beyond non-modifiable patient and caregiver factors (e.g., gender) and caregiver psychological distress (i.e., anxiety, depression, history of mental health conditions). RESULTS Preparedness for caregiving was uniquely and positively associated with Physical Health QoL (sr2 = 0.07, p = 0.001), Social QoL (sr2 = 0.05, p = 0.021), and Environmental QoL (sr2 = 0.14, p < 0.001), even after accounting for psychological distress. Mindfulness was uniquely and positively associated with Physical Health QoL (sr2 = 0.12, p < 0.001) and Psychological QoL (sr2 = 0.07, p = 0.004), above-and-beyond variance accounted for by psychological distress. CONCLUSIONS Mindfulness and preparedness for caregiving emerged as consistent, unique resiliency factors associated with greater caregiver QoL across QoL dimensions. Results highlight the importance of resiliency factors in QoL among Neuro-ICU caregivers and the need for early interventions to support resiliency.
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Affiliation(s)
- Emily L Zale
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tessa J Heinhuis
- Psychology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Institute for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Danielle Salgueiro
- Neuroscience Intensive Care Unit, Institute for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Neuroscience Intensive Care Unit, Institute for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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40
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Dzeng E, Dohan D, Curtis JR, Smith TJ, Colaianni A, Ritchie CS. Homing in on the Social: System-Level Influences on Overly Aggressive Treatments at the End of Life. J Pain Symptom Manage 2018; 55:282-289.e1. [PMID: 28865869 PMCID: PMC6329585 DOI: 10.1016/j.jpainsymman.2017.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT The American Medical System is programmed to a default setting of aggressive care for the terminally ill. Institutional norms of decision making have been shown to promote high-intensity care, regardless of consistency with patient preferences. There are myriad factors at a system, clinician, surrogate, and patient level that drive the culture of overly aggressive treatments in American hospitals. OBJECTIVE The objective of this study was to understand physician perspective of the ways systems-level factors influence patient, physician, and surrogate perceptions and consequent behavior. METHODS Semi-structured in-depth qualitative interviews with 42 internal medicine physicians across three American academic medical centers were conducted. This qualitative study was exploratory in nature, intended to enhance conceptual understanding of underlying phenomena that drive physician attitudes and behavior. RESULTS The interviews revealed many factors that contributed to overly aggressive treatments at the end of life. Systemic factors, which describe underlying cultures (including institutional, professional, or community-based cultures), typical practices of care, or systemic defaults that drive patterns of care, manifested its influence both directly and through its impact on patient, surrogate, and physician behaviors and attitudes. CONCLUSION Institutional cultures, social norms, and systemic defaults influence both normative beliefs regarding standards of care and treatments plans that may not benefit seriously ill patients.
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Affiliation(s)
- Elizabeth Dzeng
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA.
| | - Daniel Dohan
- Institute of Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Thomas J Smith
- Department of Oncology and Palliative Care, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Christine S Ritchie
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
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41
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Gallardo-Flores A, Sánchez-Medina JA, Fernández-Portero C. Perception of health, well-being, and quality of life in female caregivers: Comparative study of a sample of adult and older women in Spain. J Women Aging 2017; 30:382-398. [PMID: 28375812 DOI: 10.1080/08952841.2017.1302240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In a study on informal or unpaid care, it is difficult to identify the consequences and effects of care provision on the caregiver's daily life. Thus, it is important to analyze the perceptions of the individual caregiver. This study describes the perceptions of health, well-being, support networks, and quality of life of 13 women aged between 45 and 70 years after completing an intervention program. The data indicate that caregivers' health and quality of life worsen with the intervention, and their well-being and social relations (through new technologies) improve.
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Affiliation(s)
- Ana Gallardo-Flores
- a Social Sciences Department , Pablo de Olavide University , Seville , Spain
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42
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Tramm R, Ilic D, Murphy K, Sheldrake J, Pellegrino V, Hodgson C. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation. J Clin Nurs 2017; 26:1657-1668. [DOI: 10.1111/jocn.13566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ralph Tramm
- Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Prahan Melbourne Vic. Australia
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine (DEPM); Monash University; Prahan Melbourne Vic. Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine (DEPM); Monash University; Prahan Melbourne Vic. Australia
| | - Jayne Sheldrake
- Department of Intensive Care and Hyperbaric Medicine; The Alfred Hospital; Prahan Melbourne Vic. Australia
| | - Vincent Pellegrino
- Department of Intensive Care and Hyperbaric Medicine; The Alfred Hospital; Prahan Melbourne Vic. Australia
| | - Carol Hodgson
- Department of Epidemiology and Preventive Medicine; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Monash University; Prahan Melbourne Vic. Australia
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