Meeting the needs of critical care patients after discharge home: a qualitative exploratory study of patient perspectives

Allum, Laura; Connolly, Bronwen; McKeown, Eamonn

doi:10.1111/nicc.12305

Cited by 12 publications

(33 citation statements)

References 43 publications

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“…Lack of communication between services often resulted in a lack of understanding of the impact critical illness can have on patients and families. Allum et al, 2018, p 318), pointed out that;…”

Section: Resultsmentioning

confidence: 99%

“…Given the overall small number of ICU survivors that individual GPs or other community healthcare professionals see, this is perhaps not surprising, but does highlight a need for education on ICU survival and its longer‐term impact on patients and families. The need to address ICU survivors’ health and psychosocial needs post‐ICU has been recognised for some time by ICU healthcare professionals and some policy makers (NICE, 2009); nevertheless, we still need to develop models of care that incorporate follow‐up care and ongoing support throughout the recovery and subsequent survivorship trajectory and that are person‐centred (Allum et al, 2018; Prinjha et al, 2009; Tembo et al 2015).…”

Section: Resultsmentioning

confidence: 99%

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Theorising survivorship after intensive care: A systematic review of patient and family experiences

Kean

Donaghy

Bancroft

et al. 2021

Journal of Clinical Nursing

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Aims and Objective This systematic literature review explores and maps what we know about survivorship to understand how survivorship can be theoretically defined. Background Survivorship of critical illness has been identified as a challenge for the 21st Century. Whilst the use of the term ‘survivorship’ is now common in critical care, it has been borrowed from the cancer literature where the discourse on what survivorship means in a cancer context is ongoing and remains largely descriptive. In the absence of a theoretical understanding, the term ‘survivorship’ is often used in critical illness in a generic way, limiting our understanding of what survivorship is. The current COVID‐19 pandemic adds to an urgency of understanding what intensive care unit (ICU) survivorship might mean, given the emerging long‐term consequences of this patient cohort. We set out to explore how survivorship after critical illness is being conceptualised and what the implications might be for clinical practice and research. Design Integrated systematic literature review. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. Results The three main themes around which the reviewed studies were organised are: (a) healthcare system; (b) ICU survivors’ families; and (c) ICU survivor's identity. These three themes feed into an overarching core theme of ‘ICU Survivorship Experiences’. These themes map our current knowledge of what happens when a patient survives a critical illness and where we are in understanding ICU survivorship. Conclusion We mapped in this systematic review the different pieces of the jigsaw that emerge following critical illness to understand and see the bigger picture of what happens after patients survive critical illness. It is evident that existing research has mapped these connections, but what we have not managed to do yet is defining what survivorship is theoretically. We offer a preliminary definition of survivorship as a process but are aware that this definition needs to be developed further with patients and families.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Theorising survivorship after intensive care: A systematic review of patient and family experiences

Kean

Donaghy

Bancroft

et al. 2021

Journal of Clinical Nursing

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“…Two recent qualitative studies explored patients’ and relatives’ perspectives about hospital discharge after an ICU admission. Both emphasised the benefits of tailored patient-centred information flow to help navigate this process [6,36].…”

Section: Discussionmentioning

confidence: 99%

Information sharing between intensive care and primary care after an episode of critical illness; A mixed methods analysis

Zilahi

O’Connor

2019

PLoS ONE

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Introduction Poor quality communication between hospital doctors and GPs at the time of hospital discharge is associated with adverse patient outcomes. This may be more marked after an episode of critical illness, the complications of which can persist long after hospital discharge. Aims 1. to evaluate information sharing between ICU staff and GPs after a critical illness 2. to identify factors influencing the flow and utilisation of this information. Methods Parallel mixed methods observational study in an Irish setting, with equal emphasis on quantitative and qualitative data. Descriptive analysis was performed on quantitative data derived from GP and ICU consultant questionnaires. Qualitative data came from semi-structured interviews with GPs and consultants, and were analysed using directed content analysis. Mixing of data occurred at the stage of interpretation. Results GPs rarely received information about an episode of critical illness directly from ICU staff, with most coming from patients and relatives. Information received from hospital sources was frequently brief and incomplete. Common communication barriers reported by consultants were insufficient time, low perceived importance and difficulty establishing GP contact. When provided information, GPs seldom actioned specific interventions, citing insufficient guidance in hospital correspondence and poor knowledge about critical illness complications and their management. A majority of all respondents thought that improved information sharing would benefit patients. Cultural influences on practice were identified in qualitative data. A priori qualitative themes were: (1) perceived benefits of information sharing, (2) factors influencing current practice and (3) strategies for optimal information sharing. Emergent themes were: (4) the central role of the GP in patient care, (5) the concept of the “whole patient journey” and (6) a culture of expectation around a GP’s knowledge of hospital care. Conclusions Practical and cultural factors contribute to suboptimal information sharing between ICU and primary care doctors around an episode of critical illness in ICU. We propose a three-milestone strategy to improve the flow and utilisation of information when patients are admitted, discharged or die within the ICU.

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“…A further limitation is that recall bias may have occurred, as the period of time between the interviews and completion of the VR program was on average twelve months (patients) and six months (professionals and managers). However, another qualitative research study of the support needs of survivors of critical care found no difference in the stories of patients who underwent critical care up to five years previously [41]. This would suggest that our findings are reliable.…”

Section: Strengths and Limitationsmentioning

confidence: 53%

Usefulness and feasibility of comprehensive and less comprehensive vocational rehabilitation for patients with chronic musculoskeletal pain: perspectives from patients, professionals, and managers

Beemster

Velzen

Bennekom

et al. 2020

Disability and Rehabilitation

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Purpose: To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers. Materials and methods: Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients (n ¼ 6 C-VR, n ¼ 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis. Results: Three themes emerged for usefulness ("patient factors," "content," "dosage") and six themes emerged for feasibility ("satisfaction," "intention to continue use," "perceived appropriateness," "positive/ negative effects on target participants," "factors affecting implementation ease or difficulty," "adaptations"). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible. Conclusions:The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted. ä IMPLICATIONS FOR REHABILITATIONBoth comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient. Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and countryspecific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs.

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Meeting the needs of critical care patients after discharge home: a qualitative exploratory study of patient perspectives

Cited by 12 publications

References 43 publications

Theorising survivorship after intensive care: A systematic review of patient and family experiences

Theorising survivorship after intensive care: A systematic review of patient and family experiences

Information sharing between intensive care and primary care after an episode of critical illness; A mixed methods analysis

Usefulness and feasibility of comprehensive and less comprehensive vocational rehabilitation for patients with chronic musculoskeletal pain: perspectives from patients, professionals, and managers

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