The Patient Dignity Inventory and Dignity-Related Distress among the Critically Ill

Mergler, Blake; Goldshore, Matthew; Shea, Judy A.; Lane‐Fall, Meghan; Hadler, Rachel

doi:10.1016/j.jpainsymman.2021.12.001

Cited by 12 publications

(41 citation statements)

References 23 publications

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Section: Discussionmentioning

confidence: 99%

“…These assessments require direct, sensitive communication with patients as well as their completion of valid and reliable instruments. When evaluated, many of these patients are suffering from severe psychological distress [ 4 ]. Studies evaluating post-intensive care syndrome have been largely retrospective [ 2 , 6 - 7 ], reliant upon highly variable recall of events in the intensive care unit [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Physicians and nurses at our large rural teaching hospital treat many of the critically ill patients in the state. Our research focus has been the study of the subset of these critically ill patients who were alert and not delirious (i.e., calm, cooperative, and conversant) for multiple consecutive days [ 4 ]. The goal of the current retrospective cohort study was to estimate the percentage of the patients with multiple intensive care unit days alert and not delirious, who after being discharged alive, had follow-up assessment for post-intensive care syndrome within 15 months.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of Follow-Up Assessment for Post-Intensive Care Syndrome Among Alert and Non-Delirious Critically Ill Patients

Hadler¹,

Dexter²,

Gu³

2022

Cureus

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Introduction: Many patients surviving critical illness develop post-intensive care syndrome, a constellation of psychological, physical, and cognitive symptoms which can have long-term consequences. Physicians and nurses at our large rural teaching hospital treat many of the critically ill patients in the state. Our focus has been the subset of these critically ill patients who were alert and not delirious for multiple consecutive days. The goal of our retrospective cohort study was to estimate the percentage of the patients with multiple intensive care unit days alert and not delirious who had follow-up assessments for post-intensive care syndrome within 15 months. Methods: The inclusion criteria for the case series of randomly selected patients were: adults defined as patients aged >17 years on the date of hospital admission between October 2014 and December 2020, present in a critical care unit at noon one day and continually so for another 48 hours, and for that interval, ≥≥48 hours had every Riker sedation-agitation scale "4, calm and cooperative," as well as either all Confusion Assessment Method for the Intensive Care Unit scores negative (i.e., no delirium) or Delirium Observation Screening Scale <3 (i.e., no delirium). Each patient was then categorized as having a full oneyear follow-up if there was an encounter at our hospital between 12 and 15 months after the last date meeting study inclusion criteria. All follow-up appointments completed within 15 months of the index intensive care unit stay were screened for systematic assessment for psychological and cognitive sequelae of critical illness.Results: From a manual chart review of 366 records, 73 patients were found with follow-up ≥≥12 months. There were 21% (15/73) of the patients assessed for post-intensive care syndrome sequelae (99% confidence interval 10%-35%).Conclusions: The fact that far fewer than half the patients had documented assessments suggests that retrospective studies should not be used to judge the incidence of post-intensive care syndrome at our hospital. Prospective observational studies would be needed to judge outcomes among critically ill patients with multiple consecutive days of alert and without delirium.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Frequency of Follow-Up Assessment for Post-Intensive Care Syndrome Among Alert and Non-Delirious Critically Ill Patients

Hadler¹,

Dexter²,

Gu³

2022

Cureus

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“…Many (e.g., 20%) intensive care unit patients have one or more intervals of at least two days in the intensive care unit during which they are alert and without manifestations of delirium [1,2]. This criterion includes patients with severe illness (e.g., viral myocarditis and cardiogenic shock or spinal shock from cervical trauma, both with hemodynamic infusions).…”

Section: Introductionmentioning

confidence: 99%

“…The criterion excludes patients admitted overnight for neurological or cardiac monitoring. Despite an outward appearance of being cooperative and oriented, many of these patients have severe emotional, psychological, and existential distress [1]. Dignity-related distress can be so severe that patients desire death over their current condition [3].…”

Section: Introductionmentioning

confidence: 99%

Logistic Regression and Machine Learning Models for Predicting Whether Intensive Care Patients Who Are Alert and Without Delirium Remain As Such for at Least Two More Days

Hadler¹,

Dexter²,

Epstein³

2023

Cureus

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BackgroundSome intensive care unit patients are alert and without delirium for at least two consecutive days. These patients, like other critically ill individuals, are at risk for dignity-related distress. An interval of at least two days would provide for a palliative care multidisciplinary team to be consulted in the late morning or afternoon of day one and visit the next day. An assessment would include the administration of the validated Patient Dignity Inventory in a reflective manner. To determine whether dignity-related distress can be identified and treated during patients' intensive care unit stay, we evaluated whether a substantive fraction of such patients (≥5%) have a substantial (>90%) probability of remaining alert and without delirium in the intensive care unit for at least four consecutive days. MethodsThe retrospective cohort study used data from one large teaching hospital in the United States of America, from 2012 to June 2022. The inclusion criteria were: a) adults, b) present in an intensive care unit at 12 PM one day and continually so for the next 48 hours, c) during those two days had every Riker sedationagitation scale score "4, calm and cooperative," and d) during those two days had all Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scores negative (i.e., no delirium) and all Delirium Observation Screening Scale (DOS) scores less than three (i.e., no delirium).

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Dignity-related distress and recall among alert, non-delirious critically ill patients

Hadler,

Weeks,

et al. 2024

Pall Supp Care

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Objectives Critical illness is associated with multiple undesired impacts, including residual psychological distress, frequently associated with recollections of critical illness. Dignity-related distress is highly prevalent among the one-fifth of critically ill patients who are alert. The distress may be associated with unpleasant recollections of care. We examined whether patients at risk for dignity-related distress had recall of their reported distress approximately 1 week after assessment and whether this recall differed from another high-risk group, specifically patients undergoing dialysis for end-stage renal disease. Methods The prospective cohort study included patients with critical illness and patients with end-stage renal disease enrolled from intensive care units (ICUs) and dialysis units at 1 academic center. Distress was assessed using the Patient Dignity Inventory (PDI). Participants received in-patient or telephonic follow-up 7–10 days after the initial interaction. Follow-up encounters focused on recollection of key aspects of the interpersonal interaction as well as the content of the PDI. Results A total of 32 critically ill patients participated in initial assessment and follow-up. In total, 26 dialysis patients participated in both phases. The groups’ demographics differed. Fifty percent (n = 16) of critically ill patients and 58% (n = 15) of dialysis patients reported a mean score per item of >1.6, corresponding with severe distress on the PDI. Among the ICU patients, the 95% upper 2-sided confidence interval for the median level of recall was commensurate with the participant having had no recall of the initial interview beyond remembering that there was an interview. The end-stage renal disease group did not demonstrate significantly better recall. Significance of results Dignity-related distress is high in both critically ill patients and those with end-stage renal disease; however, recollection of assessment is poor in both groups. Any intervention designed to mitigate dignity-related distress will need either to be immediately deployable or not to be reliant upon recollection for impact.

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The Patient Dignity Inventory and Dignity-Related Distress among the Critically Ill

Cited by 12 publications

References 23 publications

Frequency of Follow-Up Assessment for Post-Intensive Care Syndrome Among Alert and Non-Delirious Critically Ill Patients

Frequency of Follow-Up Assessment for Post-Intensive Care Syndrome Among Alert and Non-Delirious Critically Ill Patients

Logistic Regression and Machine Learning Models for Predicting Whether Intensive Care Patients Who Are Alert and Without Delirium Remain As Such for at Least Two More Days

Dignity-related distress and recall among alert, non-delirious critically ill patients

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