School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Nathan Campus N48 2.14, 170 Kessels Road, Nathan, Brisbane, 4111, QLD, Australia.
Intensive Care Unit, Princess Alexandra Hospital, Building 53 Level 4, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, QLD, Australia.
Aust Crit Care. 2020 Nov;33(6):488-496. doi: 10.1016/j.aucc.2020.01.002. Epub 2020 Feb 26.
Interventions to support psychological recovery after critical illness, including information provision via an intensive care unit (ICU) diary or discharge summary, have been widely adopted in some regions, albeit without strong empirical evidence.
The objective of this study was to examine the feasibility and acceptability, for patients, family members, and clinicians, of information provision via an ICU diary or discharge summary to support psychological recovery for critical illness survivors.
This was a pilot, partially randomised patient preference study in a mixed ICU in a tertiary hospital in Australia. Eligible patients were those in the ICU for >24 h and who were able to converse in English. Interventions were ICU diary or discharge summary compared with usual care. Feasibility was assessed throughout the study process, and acceptability assessed 3 and 6 months after hospital discharge, with data analysed descriptively and thematically.
Sixty-one patients were recruited; 45 completed 3-month follow-up (74%), and 37 (61%), 6-month follow-up. Participants were medical (39%), surgical (30%), and trauma (31%) patients; aged 55 [interquartile range (IQR): 36-67] years; and stayed in the ICU for 7 [IQR: 3-13] days and hospital for 23 [IQR: 14-32] days. Within the partially randomised framework, 34 patients chose their intervention - four chose usual care, 10 ICU diary, and 20 discharge summary. The remaining 27 patients were randomised - nine usual care, 10 ICU diary, and seven discharge summary. The majority (>90%) considered each intervention helpful during recovery; however, a significant proportion of patients reported distress associated with reading the ICU diary (42%) or discharge summary (15%). Clinicians reported they were hesitant to make diary entries.
When given a choice, more patients chose a discharge summary over the ICU diary or usual care. Participants considered both interventions acceptable. Given the reports of distress associated with information provision, clear empirical evidence is required to determine effectiveness, optimal timing, support needed, and for whom they should be used.
ACTRN12615001079538.
在一些地区，包括通过重症监护病房（ICU）日记或出院总结提供信息在内的支持重病后心理康复的干预措施已经得到广泛采用，但缺乏强有力的实证证据。
本研究旨在考察 ICU 日记或出院总结为重病幸存者提供信息以支持心理康复的可行性和可接受性，针对患者、家属和临床医生。
这是在澳大利亚一家三级医院的混合 ICU 中进行的一项试点、部分随机患者偏好研究。符合条件的患者是在 ICU 中停留超过 24 小时且能够用英语交流的患者。干预措施是 ICU 日记或出院总结与常规护理相比。在整个研究过程中评估可行性，并在出院后 3 个月和 6 个月评估可接受性，使用描述性和主题分析进行数据分析。
共招募了 61 名患者；45 名患者完成了 3 个月的随访（74%），37 名（61%）患者完成了 6 个月的随访。参与者是内科（39%）、外科（30%）和创伤（31%）患者；年龄 55 岁[四分位距（IQR）：36-67]；在 ICU 住院 7 天[IQR：3-13]，在医院住院 23 天[IQR：14-32]。在部分随机框架内，34 名患者选择了他们的干预措施-4 名选择常规护理，10 名选择 ICU 日记，20 名选择出院总结。其余 27 名患者被随机分配-9 名常规护理，10 名 ICU 日记，7 名出院总结。大多数（>90%）患者认为在康复过程中每个干预措施都有帮助；然而，相当一部分患者报告说阅读 ICU 日记（42%）或出院总结（15%）时感到痛苦。临床医生报告说他们不愿意在日记中做记录。
当有选择时，更多的患者选择出院总结而不是 ICU 日记或常规护理。参与者认为两种干预措施都是可以接受的。鉴于与信息提供相关的痛苦报告，需要明确的实证证据来确定其有效性、最佳时间、所需支持以及应该为谁使用。
ACTRN12615001079538。
