Transitions of Care After Critical Illness—Challenges to Recovery and Adaptive Problem Solving*

Abstract

Objective-Investigate the challenges experienced by survivors of critical illness and their caregivers across the transitions of care from intensive care to community, and the potential problem-solving strategies used to navigate these challenges.Design-Qualitative design -data generation via interviews and data analysis via the Framework Analysis method.Setting-Patients and caregivers from three continents, identified through the Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups). Subjects-Patients and caregivers following critical illness. Interventions-NilMeasurements and Main Results-From 86 interviews (66 patients, 20 caregivers), we identified the following major themes: 1. Challenges for patients -Interacting with the health system and gaps in care; Managing others' expectations of illness and recovery; 2. Challenges for caregivers -Health system shortfalls and inadequate communication; and Lack of support for caregivers. 3. Patient and caregiver-driven problem solving across the transitions of care -Personal attributes, resources, and initiative; Receiving support and helping others; and Acceptance.Conclusions-Survivors and caregivers experienced a range of challenges across the transitions of care. There were distinct and contrasting themes related to the caregiver experience. Survivors and caregivers used comparable problem-solving strategies to navigate the challenges encountered across the transitions of care.Haines et al.

The Prevalence of Spiritual and Social Support Needs and Their Association With Postintensive Care Syndrome Symptoms Among Critical Illness Survivors Seen in a Post-ICU Follow-Up Clinic

“…across the recovery trajectory, beginning at the ICU event through months after hospital discharge (9,10). These and other qualitative studies have strongly suggested that spiritual and social supports are key facilitators for critical illness recovery (11)(12)(13).…”

“…Survivors of critical illness often report substantial physical, cognitive, and psychologic symptom burdens, which affects their quality of life, capacity to regain functional independence, and employment status for months to years after hospital discharge (1–8). In qualitative studies, critical illness survivors also describe ongoing spiritual and social support needs across the recovery trajectory, beginning at the ICU event through months after hospital discharge (9, 10). These and other qualitative studies have strongly suggested that spiritual and social supports are key facilitators for critical illness recovery (11–13).…”

Tracheostomy care and communication during COVID-19: Global interprofessional perspectives

“…As the COVID-19 pandemic has unfolded, the controversial questions of tracheostomy timing, techniques, and early outcomes [1] , [2] , [3] , [4] , [5] , [6] have sometimes eclipsed the softer voices of patients, caregivers, and front-line workers. Yet, these perspectives are critical, as they can surface underappreciated or neglected needs across the continuum of care [7] , [8] , [9] , [10] and survivorship [11] .…”

Chicken or the egg? Critical illness and mental health

“…Despite critical care being an interdisciplinary and multi-professional subject in the acute phase, critical care personnel (i.e., physicians and nurses) are usually cut off from subsequent healthcare. While ICU follow-up clinics do exist in some care models (e.g., United Kingdom), the majority of critical care survivors do not have access to ICU follow-up clinics [12][13][14]. PICS awareness in outpatient care has probably increased due to the coronavirus disease 2019 (COVID-19) pandemic and long-haul COVID-19.…”