Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic

Abstract

Background During COVID-19 pandemic, visits have been prohibited in most French ICUs. Psychological effects, for reference persons (RPs), of remote-only communication have been assessed. Methods All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death, and 3 months. At 3 months, a psychologist provided a qualitative description of RPs’ psychological distress. Results Eighty-eight RPs were included. Prevalence of anxiety and depression was 83% and 73% respectively. At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p < 0.01). Ninety-nine percent RPs felt the patient was safe (9 [7; 10]/10 points, Likert-type scale), confident with caregivers (10 [9; 10]/10 points), and satisfied with information provided (10 [9; 10]/10 points). All RPs stressed the specific-type of “responsibility” associated with being an RP in a remote-only context, leading RPs to develop narrow diffusion strategies (67%) and restrict the array of contacted relatives to a very few and/or only contacting them rarely. 10 RPs (30%) related the situation to a prior traumatic experience. Conclusion RPs experienced psychological distress and reported that being an RP in a remote-only communication context was a specific responsibility and qualified it as an overall negative experience. Trial registration NCT04385121. Registered 12 May 2020. https://clinicaltrials.gov/.

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

“…Restricted family visitation caused by the COVID-19 pandemic increased the incidence of patients' delirium three times from 1.8% to 6.2% [106]. In a restricted visitation situation, most family members experience an extra responsibility and psychological distress [107]. As a result, PICS-F was observed at 22.9% of psychological distress and 2% of PTSD [108].…”

“…However, there are several barriers associated with its implementation. The barriers include the inability to communicate owing to patient status (44%), technical difficulties (35%), lack of touch and physical presence (11%), and frequency and clarity of communications with the care team (11%) [107]. However, it is important to note that most families felt that online visitation did not completely replace in-hospital visitation [112].…”

A telepresence robot in the room of a COVID-19 patient can provide virtual family presence

“…Psychological distress has clearly increased for patients, family members, and intensive care unit (ICU) staff because of visiting restrictions. [1][2][3][4] Family members of isolated COVID-19 patients in the ICU experience moral injury with prevalence of anxiety and depression of 83% and 73%, respectively. 2 Thus, intensivists are faced with an impossible equation: (i) they should promote interactions between the relatives and the critically ill patients to prevent post-traumatic stress disorder; however, (ii) they need to ensure patient, staff, and visitor safety-and thus respect the restrictions of hospital visits.…”

“…[1][2][3][4] Family members of isolated COVID-19 patients in the ICU experience moral injury with prevalence of anxiety and depression of 83% and 73%, respectively. 2 Thus, intensivists are faced with an impossible equation: (i) they should promote interactions between the relatives and the critically ill patients to prevent post-traumatic stress disorder; however, (ii) they need to ensure patient, staff, and visitor safety-and thus respect the restrictions of hospital visits. 1 Here, we show a remote-controlled robot that helps to support communication between patients and their relatives.…”

Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic

“…Emerging evidence over the past two decades has shown a clear benefit of family/ essential caregiver presence across patient populations. [4][5][6][7][8] In response to this, a gradual relaxation of visitor restrictions has been seen over the decades. By early 2020, just prior to the COVID-19 pandemic, a review of hospitals by the Canadian Foundation for Healthcare Improvement found that 73% of hospitals had adopted accommodating visitor policies (increased from 32% in 2015).⁹…”