Coping strategies of relatives when an adult next-of-kin is recovering at home following critical illness

Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study

BACKGROUND

Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy.

OBJECTIVE

The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients.

METHODS

For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura's social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study.

RESULTS

Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022.

CONCLUSIONS

The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30813.

The expressed support needs of families of adults who have survived critical illness: A thematic synthesis

BACKGROUND

Surviving critical illness can result in ongoing psychological, physical and cognitive impairments for both survivors and families. During the time from the critical illness through to the period of adaptation back to community living, families, alongside survivors, have support needs.

OBJECTIVES

This systematic review aimed to provide an in-depth insight into the expressed support needs of families of adults who survived an admission to an intensive care unit and returned to a home environment. It also aimed to explore how these needs change over time, and what support provisions families perceived to be helpful.

METHODS

This was a systematic review using thematic synthesis methodology. Predefined searches were conducted in CINAHL, Medline, PsychINFO, SocIndex, EMbase, Academic Search Complete, EThOS and OpenGrey to locate studies published in English from 2000. Two reviewers screened each study against the inclusion criteria. Quality appraisal was undertaken using Joanna Briggs Institute tools. Extracted data were managed in Nvivo12® and analysed to identify descriptive and analytical themes. The Timing it Right Framework was used to frame changes in need across the recovery continuum.

RESULTS

Thirty-nine studies were included, 30 qualitative, eight quantitative and one mixed methods. Five key family needs were identified across the recovery continuum: for security; to make sense of the situation; finding a balance; holding everything together; and for trust.

DISCUSSION

Families found the following interventions helpful: written information; care coordination and navigation; input from intensive care staff after discharge to support continuity; and provision of family support groups. Although there are similarities between the needs of families and survivors, there are sufficient differences to warrant the development of processes to identify and address family need throughout the recovery continuum.

CONCLUSION

More research is required to develop a tool to better identify the needs of families across the recovery continuum, identify gaps in current service provision, and design interventions to meet these needs.

STUDY REGISTRATION

CRD42019136883 (PROSPERO).

Interventions in Post-Intensive Care Syndrome-Family: A Systematic Literature Review

OBJECTIVES

Data show that family members of ICU patients may have high levels of anxiety, depression, posttraumatic stress disorders, and/or complicated grief. This was previously referred to as post-intensive care syndrome-family. We systematically review randomized controlled trials for post-intensive care syndrome-family.

DATA SOURCES

Systematic research in databases (Pubmed, EMBASE, PsycINFO, CINHAL for articles published between January 2000 and October 2019).

STUDY SELECTION

Interventions in randomized controlled trials for post-intensive care syndrome-family in relatives of adult ICU patients.

DATA EXTRACTION

Review, quality assessment, and risk assessment for bias of eligible publications were performed along recommended guidelines for each investigation. Quality assessment graded studies into "strong" (n = 5), "moderate" (n = 4), and "weak" (n = 2).

DATA SYNTHESIS

Out of 2,399 publications, 11 investigations were found eligible (3,183 relatives of ICU patients). Studies addressed interventions during ICU stay (n = 6), during the post-ICU period (n = 4), or both (n = 1). Two studies included relatives of dying/deceased patients. One study implemented end-of-life conferences and showed reduced prevalence of posttraumatic stress disorder (45% vs 69%; p = 0.01), anxiety (45% vs 67%; p = 0.02), and depression (29% vs 56%; p = 0.003). Family conferences with a physician and proactive participation of a nurse reduced anxiety-scores (p = 0.01) without reducing anxiety prevalence (33.3% vs 52.3%; p = 0.08). Other studies failed to improve symptoms or reduce prevalence of post-intensive care syndrome-family. Interestingly, condolence letters may even increase prevalence of posttraumatic stress disorder (52.4% vs 37.1%; p = 0.03). Meetings without the presence of ICU physicians were shown to increase Impact of Event Scale-Revised scores (25.9 vs 21.3; p = 0.0495).

CONCLUSIONS

Only few data are available on interventions for post-intensive care syndrome-family. It appears that proactive communication and provision of information seems pivotal for post-intensive care syndrome-family treatment. Interestingly, some interventions may even worsen post-intensive care syndrome-family. In the light of the relevance of post-intensive care syndrome-family in daily ICU care, more high-quality data seems urgently needed.

Coping strategies of family members of intensive care unit patients

OBJECTIVE

To analyse the coping strategies of family members of patients admitted to intensive care units.

DESIGN

A cross-sectional study developed with 70 relatives of patients admitted to the intensive care unit.

SETTING

An adult intensive care unit at a university hospital in Brazil.

MAIN OUTCOME MEASURES

Coping strategies were identified by the Folkman and Lazarus Inventory of Coping Strategies and statistically compared to the sociodemographic data of family members and patients' clinical data.

RESULTS

Coping strategies focused on emotion were the most used, especially those attributed to the escape-avoidance factor. There was a significant association (p < 0.05) between women and the use of adaptive strategies focused on the problem; less education and lower income with maladaptive strategies focused on emotion; second-degree relatives and the positive reassessment factor; participants involved in religious activities and the social support factor. Regarding the clinical variables, patients admitted to the intensive care unit for more than seven days showed an association (p < 0.05) with the social support factor.

CONCLUSION

Family members used adaptive coping strategies more focused on emotion. Additionally, the lower the educational and economic levels, the greater the use of maladaptive strategies focused on emotion.

A vulnerable population: families of patients in adult critical care

Families of patients in adult critical care are susceptible to physiological symptoms, emotional distress, persuasion, burden, and postintensive care syndrome-family, as defined by the Society of Critical Care Medicine. The specific aims of this article are to (1) describe the state of science about the concept of vulnerability of families of patients in adult critical care, through analysis and synthesis of relevant literature; (2) explore resources available to reduce or prevent vulnerability of this population; and (3) propose considerations for research with this population. Concept analysis and synthesis strategies support the definition of this concept through review of the literature to describe antecedents, defining characteristics, and consequences of the vulnerability of families of patients in adult critical care. The authors present resources for both families and health care professionals and recommendations for potential collaborative efforts that could reduce risks and promote the health of this vulnerable population.

A Vulnerable Population

Families of patients in adult critical care are susceptible to physiological symptoms, emotional distress, persuasion, burden, and postintensive care syndrome—family, as defined by the Society of Critical Care Medicine. The specific aims of this article are to (1) describe the state of science about the concept of vulnerability of families of patients in adult critical care, through analysis and synthesis of relevant literature; (2) explore resources available to reduce or prevent vulnerability of this population; and (3) propose considerations for research with this population. Concept analysis and synthesis strategies support the definition of this concept through review of the literature to describe antecedents, defining characteristics, and consequences of the vulnerability of families of patients in adult critical care. The authors present resources for both families and health care professionals and recommendations for potential collaborative efforts that could reduce risks and promote the health of this vulnerable population.

Family adaptation in relation to a family member's stay in ICU

OBJECTIVES

To describe and interpret the family adaptation during the ICU hospitalisation and up to 18 months after discharge.

RESEARCH METHODOLOGY/DESIGN

A qualitative design was chosen.

MAIN OUTCOME MEASURES

Individual and family interviews with eight families including 31 family members. A hermeneutical analysis was performed and paradigm cases were constructed.

RESULTS

The result is presented in three themes: striving for endurance, striving for consolation and striving to rebuild life under new conditions. The family adaptation started at the onset of the critical incident and continued during the ICU stay and after discharge. The family members metaphorically went through peaks and valleys during the whole process of adaptation.

CONCLUSION

Adaptation is an issue for the whole family and is facilitated by being able to stay close to the patient and receive supportive unambiguous information from the staff both during the ICU stay and after discharge.

Short- and long-term impact of critical illness on relatives: literature review

AIM

This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives.

BACKGROUND

Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care.

DATA SOURCES

The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials.

SEARCH METHODS

Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions', 'satisfaction', 'psychological outcomes' and 'coping'.

RESULTS

Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives.

CONCLUSION

Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.

Theoretical model of coping among relatives of patients in intensive care units: a simultaneous concept analysis

This paper reports the development of a theoretical model of relatives' coping approaches during the patient's intensive care unit stay and subsequent recovery at home by performing an analysis of concepts generated from two empirically grounded, theoretical studies in this area.

BACKGROUND

When supporting relatives of intensive care unit patients, it is important that nurses have access to evidence-based knowledge of relatives' coping approaches during the period of illness and recovery.

METHOD

Simultaneous concept analysis was used to refine and combine multiple coping concepts into a theoretical model of coping. The concepts were generated in two previous empirical studies of relatives' coping approaches during mechanically ventilated patients' intensive care unit stays and recovery at home.

FINDINGS

The theoretical model was developed in 2004-2005 and illustrates the effectiveness of different coping approaches in relation to each other and to social support. Definitions summarizing each coping approach and containing the knowledge gained through the simultaneous concept analysis method were also formulated.

CONCLUSION

This middle-range theory of relatives' coping approaches may make a valuable contribution to international intensive care unit nursing practice, especially as it is based on empirical studies and may therefore serve as a basis for the development of future clinical guidelines. However, the theoretical model needs to be empirically validated before it can be used.

What is supportive when an adult next-of-kin is in critical care?

There is little documented knowledge about what is supportive from the perspective of relatives with a critically ill next-of-kin in the intensive care unit (ICU). The aim of the present study was to generate a theoretical understanding of what relatives experience as supportive when faced with the situation of having an adult next-of-kin admitted to critical care. The study was designed using a grounded theory methodology. Interviews were conducted with 29 adult relatives of adult ICU patients in southwest Sweden. Relatives described the need to be empowered and that support was needed to enable them to use both internal and external resources to cope with having a next-of-kin in critical care. To achieve empowerment, the relatives described the need to trust in oneself, to encounter charity and to encounter professionalism. The findings can contribute understanding and sensitivity to the situation of the relatives as well as indicating what form social support should take. It is essential that healthcare professionals understand how important it is for relatives to have control over their vulnerable situation and that they also reflect upon how they would like to be treated themselves in a similar situation. Recommendations for future practice are presented.