Exploring Patients' Goals Within the Intensive Care Unit Rehabilitation Setting

Joanne M. McPeake, PhD; Michael O. Harhay, PhD; Helen Devine, MSc; Theodore J. Iwashyna, PhD, MD; Pamela MacTavish, MSc; Mark Mikkelsen, MD, MSCE; Martin Shaw, PhD; Tara Quasim, MD

Disclosures

Am J Crit Care. 2019;28(5):393-400. 

In This Article

Abstract and Introduction

Abstract

Background: The number of patients surviving critical care is increasing. Quality of life after critical care is known to be poor for some patients. The evidence base for effective rehabilitation interventions in the period following a stay in an intensive care unit is limited.

Objectives: To understand what rehabilitation goals are important to patients after critical care discharge.

Methods: This prospective study, which was undertaken during an intensive care unit recovery program, explored the recovery goals of 43 patients. Framework analysis was used to extract prevalent themes and identify the important components of recovery from the patients' perspective.

Results: Participants described diverse goals for their post–intensive care unit recovery. Most goals were about health-related quality of life, including physical goals and rehabilitation. Although health was central to many of the participants' individual recovery aims, themes of family and social engagement and adopting appropriate goal trajectories also emerged within patient goals. Individual strategies for reaching these goals varied, and patients had different aspirations about what they could achieve.

Conclusions: Patients' aspirations for their intensive care unit recovery are diverse. Design of postdischarge care can be informed by this greater understanding of the heterogeneous starting points and goal trajectories of survivors of critical illness.

Introduction

More than 6 million patients are admitted to intensive care units (ICUs) each year in the United States alone.[1] As a result of advances in technology and care delivery, the vast majority of patients now survive an ICU stay.[2] A decade of work has shown that patients encounter physical, psychosocial, and emotional problems months and years after critical illness.[3–6] This broad constellation of challenges to individual well-being following hospital discharge is referred to as post–intensive-care syndrome.[7] Family members and caregivers also experience related challenges.[8,9] Survivorship is viewed as the defining challenge of modern-day critical care.[2]

Interventions within the ICU, such as patient diaries and early mobilization, have been shown to improve outcomes for critically ill patients, but thus far little evidence indicates that outpatient interventions improve outcomes.[10–14] Strategies such as ICU follow-up clinics and peer support programs have been proposed to help alleviate issues related to post–intensive care syndrome. However, no trial or interventional study has shown any outcome benefit for patients. As a result, researchers are seeking to understand where they should focus their efforts.[15]

"Patients encounter physical, psychosocial, and emotional problems after critical care."

Explanations that have been suggested for why these seemingly intuitive interventions have been ineffective include lack of understanding of the social and less measurable aspects of recovery, inappropriate trial design or outcome measures, and lack of understanding of the patient's perspective on what is needed.[16,17] The aim of this study was to analyze patient recovery goals to shed light on what the important components of a successful ICU rehabilitation program may be.

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