1 Division of Pulmonary and Critical Care Medicine, Department of Medicine.
2 Duke Program to Support People and Enhance Recovery.
Am J Respir Crit Care Med. 2018 Jan 1;197(1):66-78. doi: 10.1164/rccm.201704-0720OC.
Many survivors of critical illness and their family members experience significant psychological distress after patient discharge.
To compare the effects of a coping skills training (CST) program with an education program on patient and family psychological distress.
In this five-center clinical trial, adult patients who received mechanical ventilation for more than 48 hours and one family member of each patient were randomized to six weekly CST telephone sessions plus access to a study website or a critical illness education program.
The primary outcome was the patient Hospital Anxiety and Depression Scale (HADS) score at 3 months. Secondary outcomes included 3- and 6-month HADS subscales and the Impact of Events Scale-Revised. Among the 175 patients randomized to CST (n = 86) or education (n = 89), there was no significant difference between CST and education in either 3-month HADS scores (difference, 1.3; 95% confidence interval [CI], -0.9 to 3.4; P = 0.24) or secondary patient and family outcomes. In prespecified analyses, among patients with high baseline distress (n = 60), CST recipients had greater improvement in 6-month HADS score (difference, -4.6; 95% CI, -8.6 to -0.6; P = 0.02) than the education group. Among patients ventilated longer than 7 days (n = 47), education recipients had greater improvement in 3-month HADS score (difference, -4.0; 95% CI, -8.1 to -0.05; P = 0.047) than the CST group.
CST did not improve psychological distress symptoms compared with an education program. However, CST improved symptoms of distress at 6 months among patients with high baseline distress, whereas the education program improved distress at 3 months among those ventilated for more than 7 days. Future efforts to address psychological distress among critical illness survivors should target high-risk populations. Clinical trial registered with www.clinicaltrials.gov (NCT01983254).
许多危重病幸存者及其家属在患者出院后会经历明显的心理困扰。
比较应对技能训练（CST）计划与教育计划对患者和家属心理困扰的影响。
在这项五中心临床试验中，接受机械通气超过 48 小时的成年患者及其每位患者的一名家属被随机分配到六次每周 CST 电话会议，以及获得研究网站或危重病教育计划的机会。
主要结局是患者 3 个月时的医院焦虑和抑郁量表（HADS）评分。次要结局包括 3 个月和 6 个月时的 HADS 子量表和修订后的事件影响量表。在随机分配到 CST（n=86）或教育（n=89）的 175 名患者中，CST 与教育在 3 个月时的 HADS 评分（差值，1.3；95%置信区间[CI]，-0.9 至 3.4；P=0.24）或次要患者和家庭结局方面均无显著差异。在预先指定的分析中，在基线时存在较高心理困扰的患者（n=60）中，CST 组患者在 6 个月时 HADS 评分的改善更大（差值，-4.6；95%CI，-8.6 至-0.6；P=0.02），而教育组患者则无显著差异。在通气时间超过 7 天的患者中（n=47），教育组患者在 3 个月时 HADS 评分的改善更大（差值，-4.0；95%CI，-8.1 至-0.05；P=0.047），而 CST 组患者则无显著差异。
与教育计划相比，CST 并未改善心理困扰症状。然而，CST 改善了基线时心理困扰较高患者的 6 个月时的症状，而教育计划改善了通气时间超过 7 天的患者的 3 个月时的症状。未来应对危重病幸存者心理困扰的努力应针对高危人群。该临床试验已在 www.clinicaltrials.gov 注册（NCT01983254）。
