1
|
Freeman-Sanderson A, Brodsky MB, Dale C, Gupta A, Haines K, Happ MB, Hart N, Hemsley B, Istanboulian L, Spronk P, Sullivan R, Sutt AL, Rose L. A Core Outcome Set for Research Evaluating Interventions to Enable Communication in Patients With an Artificial Airway: An International Delphi Consensus Study (Comm-COS). Crit Care Med 2024; 52:e450-e462. [PMID: 38899947 PMCID: PMC11321605 DOI: 10.1097/ccm.0000000000006347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population. DESIGN 1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages. SETTING Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting. SUBJECTS Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention. CONCLUSIONS This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity.
Collapse
Affiliation(s)
- Amy Freeman-Sanderson
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Speech Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Anushua Gupta
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Speech Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Department of Physiotherapy, Western Health, Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- The Ohio State University College of Nursing, Columbus, OH
- Guy’s and St Thomas NHS Foundation Trust, London, United Kingdom
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, ON, Canada
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, The Netherlands
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Kimberley Haines
- Department of Physiotherapy, Western Health, Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH
| | - Nicholas Hart
- Guy’s and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Bronwyn Hemsley
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Laura Istanboulian
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, ON, Canada
| | - Peter Spronk
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Rebecca Sullivan
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| |
Collapse
|