Psychological Distress Decreased When Families Completed Daily ICU Diary
Abstract & Commentary
Psychological Distress Decreased When Families Completed Daily ICU Diary
By Leslie A. Hoffman, RN, PhD, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, is Associate Editor for Critical Care Alert.
Synopsis: Family members who received a diary written during their family member's ICU admission had lower levels of symptoms related to post-traumatic stress disorder.
Source: Jones C, et al. Intensive care diaries and relatives' symptoms of posttraumatic stress disorder after critical illness: A pilot study. Am J Crit Care 2012;21:172-176.
Family members of patients recovering from critical illness may experience psychological problems, including anxiety, depression, and post-traumatic stress disorder (PTSD). Jones and colleagues reasoned that provision of an ICU diary, written in everyday language by ICU staff, would be beneficial to family members by providing an explanation of daily events and opportunity for expression of feelings and contribution to the plan of care. Subjects were family members of patients who were admitted to the ICU for > 72 hours and mechanically ventilated for > 24 hours. The recruitment sites were two general adult ICUs in England and Sweden. The median ICU stay for patients enrolled in the study was 14 days (range, 4-50 days).
Each patient had a diary written for them by staff while they were in the ICU and family members contributed if they wished. At discharge from the ICU, patients and family members were randomized into two groups: one received the diary as soon as they wished but within 2 months of discharge (n = 15), and the second group at 3 months after discharge (n = 15). There were no significant differences between groups in age, length of ICU stay, hours of mechanical ventilation, or APACHE II scores. Family members completed a standardized questionnaire designed to detect PTSD symptoms 1 and 3 months following ICU discharge. At 3 months, scores reflecting PTSD symptoms were significantly lower (P = 0.03) in the group that received the diary within 2 months of discharge, indicating fewer PTSD symptoms.
Commentary
This study, conducted in two European ICUs, provides interesting information regarding potential benefits of a simple intervention that may decrease psychological distress following ICU admission. The authors relate that ICU diaries are in "wide use" in Scandinavia and the United Kingdom, but the benefits of this practice have rarely been evaluated. Findings of their study are similar to those reported by a French group1 from a study enrolling a similar-sized sample (n = 49) followed over a longer period. In the French study, scores reflecting PTSD symptoms were decreased at 12 months, but not at 3 months.
Both studies had a number of limitations: sample size was small and reported benefits did not occur until months after ICU discharge, raising the potential that intervening events were responsible for the change. Nevertheless, provision of the diary was not reported to cause any ill effects and patients and family members had the option of not reading its content. The structure of the French diary was similar to an information booklet; it included an organizational chart of the ICU with staff photos and a photo of an empty ICU bed with explanations of equipment and monitoring systems. Photos of a mechanical ventilator and other equipment were added if used. The first entry was contributed by the ICU physician who summarized the patient's medical history and condition. ICU staff contributed to the following pages by writing a daily narrative in everyday language that provided a status update. Family members contributed as they wished. At discharge, an ICU staff member wrote a conclusion expressing wishes for a good recovery. This intervention merits consideration as a means to reduce patient distress: it is simple to implement, has potential benefit, and has no apparent untoward effects.
Reference
- Garrouste-Orgeas M, et al. Impact of an intensive care unit diary on psychological distress in patients and relatives. Crit Care Med 2012;40:2033-2040.
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