Defining patient-centered recovery after critical illness - A qualitative study

Lynda M Thurston; Sharyn L Milnes; Carol L Hodgson; Danielle E Berkovic; Darshini R Ayton; Theodore J Iwashyna; Neil R Orford

doi:10.1016/j.jcrc.2020.01.028

Defining patient-centered recovery after critical illness - A qualitative study

J Crit Care. 2020 Jun:57:84-90. doi: 10.1016/j.jcrc.2020.01.028. Epub 2020 Feb 6.

Authors

Lynda M Thurston¹, Sharyn L Milnes², Carol L Hodgson³, Danielle E Berkovic⁴, Darshini R Ayton⁵, Theodore J Iwashyna⁶, Neil R Orford⁷

Affiliations

¹ University Hospital Geelong, Barwon Health, Geelong, VIC, Australia. Electronic address: lynda.thurston@barwonhealth.org.au.
² University Hospital Geelong, Barwon Health, Geelong, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia. Electronic address: smilnes@barwonhealth.org.au.
³ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia. Electronic address: carol.hodgson@monash.edu.
⁴ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: danielle.berkovic@monash.edu.
⁵ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: Darshini.Ayton@monash.edu.
⁶ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA. Electronic address: tiwashyn@umich.edu.
⁷ University Hospital Geelong, Barwon Health, Geelong, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: orfords@me.com.

PMID: 32062290
DOI: 10.1016/j.jcrc.2020.01.028

Abstract

Purpose: To explore perspectives of adult critical illness survivors and identify important aspects to care and recovery.

Materials and methods: A descriptive, qualitative study of adult survivors of prolonged critical illness, six-months after Intensive Care Unit (ICU) discharge, using semi-structured interviews and thematic analysis. The study was undertaken in an academic, tertiary, regional hospital in Victoria, Australia.

Results: Thirty-five patients participated in the study. Most were male (69%) with median age 64 years. Admissions were predominantly medical (51%), followed by cardiothoracic (26%) and general surgical (23%). Median ICU and hospital length of stay were 5 and 17 days respectively. Qualitative analysis revealed two key theme categories, recovery status and care experience. Three recovery states were identified based on physical and neuropsychological recovery. Care experiences varied across recovery states, including care encounters, communication, support and impact on family and friends, and use of community health services.

Conclusion: Critical illness survivors frame their recovery in terms of recovery status and care experience, reflecting existing qualitative domains of physical health, psychological health, cognitive function, social health and life satisfaction. Theme content varied with recovery status, raising the possibility that modifying care experiences or patient perceptions could change recovery outcomes.

Keywords: Intensive care; Patient-centered outcomes research; Qualitative research; Recovery of function; Survivorship.

MeSH terms

Adult
Aged
Critical Care
Critical Illness / psychology*
Female
Humans
Intensive Care Units*
Male
Mental Health
Middle Aged
Patient Discharge
Patient Satisfaction
Patient-Centered Care*
Qualitative Research*
Survivors / psychology*
Treatment Outcome
Victoria
Young Adult