Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients

Abstract

for the POPPI Trial Investigators IMPORTANCE A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms of 25%.OBJECTIVE To determine whether a nurse-led preventive, complex psychological intervention, initiated in the ICU, reduces patient-reported PTSD symptom severity at 6 months. DESIGN, SETTING, AND PARTICIPANTSA multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted in 24 ICUs in the United Kingdom. Participants were critically ill patients who regained mental capacity following receipt of level 3 (intensive) care. A total of 2961 eligible patients were identified from September 2015 to January 2017. A total of 2048 were approached for participation in the ICU, of which 1458 provided informed consent. Follow-up was completed December 2017.INTERVENTIONS Twenty four ICUs were randomized 1:1 to the intervention or control group. Intervention ICUs (n = 12; 669 participants) delivered usual care during a baseline period followed by an intervention period. The preventive, complex psychological intervention comprised promotion of a therapeutic ICU environment plus 3 stress support sessions and a relaxation and recovery program delivered by trained ICU nurses to high-risk (acutely stressed) patients. Control ICUs (n = 12; 789 participants) delivered usual care in both baseline and intervention periods. MAIN OUTCOMES AND MEASURESThe primary clinical outcome was PTSD symptom severity among survivors at 6 months measured using the PTSD Symptom Scale-Self-Report questionnaire (score range, 0-51, with higher scores indicating greater symptom severity; the minimal clinically important difference was considered to be 4.2 points). RESULTSAmong 1458 enrolled patients (mean [SD] age, 58 [16] years; 599 women [41%]), 1353 (93%) completed the study and were included in the final analysis. At 6 months, the mean PTSD Symptom Scale-Self-Report questionnaire score in intervention ICUs was 11.8 (baseline period) compared with 11.5 (intervention period) (difference, −0.40 [95% CI, −2.46 to 1.67]) and in control ICUs, 10.1 (baseline period) compared with 10.2 (intervention period) (difference, 0.06 [95% CI, −1.74 to 1.85]) between periods. There was no significant difference in PTSD symptom severity at 6 months (treatment effect estimate [difference in differences] of −0.03 [95% CI, −2.58 to 2.52]; P = .98).CONCLUSIONS AND RELEVANCE Among critically ill patients in the ICU, a nurse-led preventive, complex psychological intervention did not significantly reduce patient-reported PTSD symptom severity at 6 months. These findings do not support the use of this psychological intervention.

A nurse-led, preventive, psychological intervention to reduce PTSD symptom severity in critically ill patients: the POPPI feasibility study and cluster RCT

“…Reproduced with permission from JAMA 2019;321 (7):665-75. 71 Copyright © 2019 American Medical Association. All rights reserved.…”

“…Reproduced with permission from JAMA 2019;321(7):665-75. 71 Cost-effectiveness acceptability curve, reporting the probability that the intervention is cost-effective (at lifetime) at alternative willingness-to-pay thresholds for a QALY gain. Reproduced with permission from JAMA 2019;321 (7):665-75.…”

“…Numbers 3, 2, 1 and 0 represent scores for the implementation of each of the intervention components. Reproduced with permission from JAMA 2019;321(7):665-75 71. Copyright © 2019 American Medical Association.…”

“…Monthly POPPI online training uptake at each intervention group site (n = 12) from the transition month until the end of intervention period. Reproduced with permission from JAMA 2019;321(7):665-75 71. Copyright © 2019 American Medical Association.…”

“…Uncertainty in the mean costs (GBP) and QALY differences and their distribution for the POPPI intervention versus usual care. Reproduced with permission from JAMA 2019;321(7):665-75 71. Copyright © 2019 American Medical Association.…”