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Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
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King J, O’Neill B, Ramsay P, Linden MA, Darweish Medniuk A, Outtrim J, Blackwood B. Identifying patients' support needs following critical illness: a scoping review of the qualitative literature. Crit Care 2019; 23:187. [PMID: 31126335 PMCID: PMC6533750 DOI: 10.1186/s13054-019-2441-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting recovery is an international priority. As survivors' transition from the intensive care unit to home, their support needs develop and change. METHODS In this scoping review, we categorised patients' support needs using House's Social Support Needs framework (informational, emotional, instrumental, appraisal) and mapped these against the Timing it Right framework reflecting the patient's transition from intensive care (event/diagnosis) to ward (stabilisation/preparation) and discharge home (implementation/adaptation). We searched electronic databases from 2000 to 2017 for qualitative research studies reporting adult critical care survivors' experiences of care. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. RESULTS From 3035 references, we included 32 studies involving 702 patients. Studies were conducted in UK and Europe (n = 17, 53%), Canada and the USA (n = 6, 19%), Australasia (n = 6, 19%), Hong Kong (n = 1, 3%), Jordan (n = 1, 3%) and multi-country (n = 1, 3%). Across the recovery trajectory, informational, emotional, instrumental, appraisal and spiritual support needs were evident, and the nature and intensity of need differed when mapped against the Timing it Right framework. Informational needs changed from needing basic facts about admission, to detail about progress and treatments and coping with long-term sequelae. The nature of emotional needs changed from needing to cope with confusion, anxiety and comfort, to a need for security and family presence, coping with flashbacks, and needing counselling and community support. Early instrumental needs ranged from managing sleep, fatigue, pain and needing nursing care and transitioned to needing physical and cognitive ability support, strength training and personal hygiene; and at home, regaining independence, strength and return to work. Appraisal needs related to obtaining feedback on progress, and after discharge, needing reassurance from others who had been through the ICU experience. CONCLUSIONS This review is the first to identify the change in social support needs among intensive care survivors as they transition from intensive care to the home environment. An understanding of needs at different transition periods would help inform health service provision and support for survivors.
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Affiliation(s)
- J. King
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - B. O’Neill
- Centre for Health and Rehabilitation Technologies, INHR, Ulster University, Newtownabbey, Northern Ireland, UK
| | - P. Ramsay
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - M. A. Linden
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - A. Darweish Medniuk
- Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - J. Outtrim
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, England, UK
| | - B. Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
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Huynh TG, Covalesky M, Sinclair S, Gunter H, Norton T, Chen A, Yi C. Measuring Outcomes of an Intensive Care Unit Family Diary Program. AACN Adv Crit Care 2018; 28:179-190. [PMID: 28592478 DOI: 10.4037/aacnacc2017862] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Patients discharged from intensive care units are at risk of short- and long-term physical, cognitive, and emotional symptoms known as post-intensive care syndrome. Family members of intensive care unit patients are at risk of similar symptoms known as post-intensive care syndrome-family. Both syndromes are common, and strategies to reduce risk factors should be employed. An intensive care unit diary project to help reduce these syndromes was implemented in 2 intensive care units using an evidence-based framework. The effects of these diaries were studied using the Family Satisfaction with Care in the Intensive Care Unit survey. Rates of referrals to a postintensive care unit recovery clinic were also observed in relation to the diaries. Although preliminary data did not reveal a significant increase in family satisfaction, the surveys provided important staff feedback. The diaries fostered feelings of compassion and caring as well as built trust between staff and family members of intensive care unit patients. The diaries increased referrals to the postintensive care unit recovery clinic.
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Affiliation(s)
- Truong-Giang Huynh
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
| | - Miranda Covalesky
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
| | - Samantha Sinclair
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
| | - Heather Gunter
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
| | - Tamara Norton
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
| | - Alice Chen
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
| | - Cassia Yi
- Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, 9300 Campus Point Drive, La Jolla, CA 92037 . Miranda Covalesky is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Samantha Sinclair is Clinical Nurse II, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Heather Gunter is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Tamara Norton is Clinical Nurse III, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California. Alice Chen is Clinical Nurse III, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Cassia Yi is Critical Care Clinical Nurse Specialist, Sulpizio Cardiovascular Center, University of California, San Diego Health, La Jolla, California
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Robinson KA, Davis WE, Dinglas VD, Mendez-Tellez PA, Rabiee A, Sukrithan V, Yalamanchilli R, Turnbull AE, Needham DM. A systematic review finds limited data on measurement properties of instruments measuring outcomes in adult intensive care unit survivors. J Clin Epidemiol 2016; 82:37-46. [PMID: 27865899 DOI: 10.1016/j.jclinepi.2016.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE There is a growing number of studies evaluating the physical, cognitive, mental health, and health-related quality of life (HRQOL) outcomes of adults surviving critical illness. However, there is little consensus on the most appropriate instruments to measure these outcomes. To inform the development of such consensus, we conducted a systematic review of the performance characteristics of instruments measuring physical, cognitive, mental health, and HRQOL outcomes in adult intensive care unit (ICU) survivors. METHODS We searched PubMed, Embase, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and The Cochrane Library in March 2015. We also conducted manual searches of reference lists of eligible studies and relevant review articles. Two people independently selected studies, completed data abstraction, and assessed the quality of eligible studies using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist. RESULTS We identified 20 studies which explicitly evaluated measurement properties for 21 different instruments assessing outcomes in ICU survivors. Eleven of the instruments assessed quality of life, with few instruments assessing other domains. Of the nine measurement properties evaluated on the COSMIN checklist, six were assessed in <10% of the evaluations. Overall quality of eligible studies was generally poor to fair based on the COSMIN checklist. CONCLUSIONS Although an increasing number of studies measure physical, cognitive, mental health, and HRQOL outcomes in adult ICU survivors, data on the measurement properties of such instruments are sparse and generally of poor to fair quality. Empirical analyses evaluating the performance of instruments in adult ICU survivors are needed to advance research in this field.
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Affiliation(s)
- Karen A Robinson
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA.
| | - Wesley E Davis
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Pedro A Mendez-Tellez
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Anahita Rabiee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Vineeth Sukrithan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Ramakrishna Yalamanchilli
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA
| | - Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21287, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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