Development of the support needs after ICU (SNAC) questionnaire

Abstract

Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks,(3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post-hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test-retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one-way ANOVA. Results:The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test-retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions:The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice:The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post-hospital support services.

Recovery following discharge from intensive care: What do patients think is helpful and what services are missing?

“…The demographics of the population are broadly similar to other studies assessing patients following discharge from ICU [19,20]. The mean clinical frailty score of the participants indicated a vulnerable population who were in the early stage of hospital discharge.…”

“…occupational therapy, clinical psychology, GP. To fill these gaps for support and services, individual patient assessment could personalise recovery strategies according to patient needs [ 19 , 25 ]. Identifying self-referral opportunities could be sufficient for others, especially if they are highly motivated [ 26 ].…”

“…Overall, the study findings provide a range of strategies that could be used to fill the perceived gaps that patients identified and to support patient recovery in the future. We have organised these strategies according to support needs categories that have been identified in other research studies in this area ( Table 2 ) [ 14 , 19 , 30 , 32 ]. This includes ways to support informational needs, such as signposting to other services; support for emotional needs, e.g.…”