Christopher E Cox1,2, Catherine L Hough3, Shannon S Carson4, Douglas B White5, Jeremy M Kahn5, Maren K Olsen6,7, Derek M Jones1,2, Tamara J Somers8, Sarah A Kelleher8, Laura S Porter8. 1. 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine. 2. 2 Duke Program to Support People and Enhance Recovery. 3. 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington. 4. 4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina. 5. 5 Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and. 6. 6 Department of Biostatistics, and. 7. 7 Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina. 8. 8 Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.
Abstract
RATIONALE: Many survivors of critical illness and their family members experience significant psychological distress after patient discharge. OBJECTIVES: To compare the effects of a coping skills training (CST) program with an education program on patient and family psychological distress. METHODS: In this five-center clinical trial, adult patients who received mechanical ventilationfor more than 48 hours and one family member of each patient were randomized to six weekly CST telephone sessions plus access to a study website or a critical illness education program. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the patient Hospital Anxiety and Depression Scale (HADS) score at 3 months. Secondary outcomes included 3- and 6-month HADS subscales and the Impact of Events Scale-Revised. Among the 175 patients randomized to CST (n = 86) or education (n = 89), there was no significant difference between CST and education in either 3-month HADS scores (difference, 1.3; 95% confidence interval [CI], -0.9 to 3.4; P = 0.24) or secondary patient and family outcomes. In prespecified analyses, among patients with high baseline distress (n = 60), CST recipients had greater improvement in 6-month HADS score (difference, -4.6; 95% CI, -8.6 to -0.6; P = 0.02) than the education group. Among patients ventilated longer than 7 days (n = 47), education recipients had greater improvement in 3-month HADS score (difference, -4.0; 95% CI, -8.1 to -0.05; P = 0.047) than the CST group. CONCLUSIONS:CST did not improve psychological distress symptoms compared with an education program. However, CST improved symptoms of distress at 6 months among patients with high baseline distress, whereas the education program improved distress at 3 months among those ventilated for more than 7 days. Future efforts to address psychological distress among critical illness survivors should target high-risk populations. Clinical trial registered with www.clinicaltrials.gov (NCT01983254).
RCT Entities:
RATIONALE: Many survivors of critical illness and their family members experience significant psychological distress after patient discharge. OBJECTIVES: To compare the effects of a coping skills training (CST) program with an education program on patient and family psychological distress. METHODS: In this five-center clinical trial, adult patients who received mechanical ventilation for more than 48 hours and one family member of each patient were randomized to six weekly CST telephone sessions plus access to a study website or a critical illness education program. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the patient Hospital Anxiety and Depression Scale (HADS) score at 3 months. Secondary outcomes included 3- and 6-month HADS subscales and the Impact of Events Scale-Revised. Among the 175 patients randomized to CST (n = 86) or education (n = 89), there was no significant difference between CST and education in either 3-month HADS scores (difference, 1.3; 95% confidence interval [CI], -0.9 to 3.4; P = 0.24) or secondary patient and family outcomes. In prespecified analyses, among patients with high baseline distress (n = 60), CST recipients had greater improvement in 6-month HADS score (difference, -4.6; 95% CI, -8.6 to -0.6; P = 0.02) than the education group. Among patients ventilated longer than 7 days (n = 47), education recipients had greater improvement in 3-month HADS score (difference, -4.0; 95% CI, -8.1 to -0.05; P = 0.047) than the CST group. CONCLUSIONS: CST did not improve psychological distress symptoms compared with an education program. However, CST improved symptoms of distress at 6 months among patients with high baseline distress, whereas the education program improved distress at 3 months among those ventilated for more than 7 days. Future efforts to address psychological distress among critical illness survivors should target high-risk populations. Clinical trial registered with www.clinicaltrials.gov (NCT01983254).
Authors: Neil P Roberts; Neil J Kitchiner; Justin Kenardy; Lindsay Robertson; Catrin Lewis; Jonathan I Bisson Journal: Cochrane Database Syst Rev Date: 2019-08-08
Authors: Christopher E Cox; Catherine L Hough; Derek M Jones; Anna Ungar; Wen Reagan; Mary D Key; Tina Gremore; Maren K Olsen; Linda Sanders; Jeffrey M Greeson; Laura S Porter Journal: Thorax Date: 2018-05-23 Impact factor: 9.139
Authors: Jeffrey L Birk; Jennifer A Sumner; Mytra Haerizadeh; Reuben Heyman-Kantor; Louise Falzon; Christopher Gonzalez; Liliya Gershengoren; Peter Shapiro; Donald Edmondson; Ian M Kronish Journal: J Anxiety Disord Date: 2019-03-20
Authors: Blair Wendlandt; Agathe Ceppe; Summer Choudhury; Judith E Nelson; Christopher E Cox; Laura C Hanson; Marion Danis; James A Tulsky; Shannon S Carson Journal: Ann Am Thorac Soc Date: 2018-12
Authors: Emily A Harlan; Jacquelyn Miller; Deena K Costa; Angela Fagerlin; Theodore J Iwashyna; Emily P Chen; Kyra Lipman; Thomas S Valley Journal: Chest Date: 2020-05-24 Impact factor: 9.410
Authors: Nita Khandelwal; Catherine L Hough; Lois Downey; Ruth A Engelberg; Shannon S Carson; Douglas B White; Jeremy M Kahn; Derek M Jones; Mary D Key; Wen Reagan; Laura S Porter; J Randall Curtis; Christopher E Cox Journal: Crit Care Med Date: 2018-06 Impact factor: 7.598
Authors: Blair Wendlandt; Agathe Ceppe; Summer Choudhury; Christopher E Cox; Laura C Hanson; Marion Danis; James A Tulsky; Judith E Nelson; Shannon S Carson Journal: Intensive Care Med Date: 2019-02-21 Impact factor: 17.440
Authors: Christopher E Cox; Maren K Olsen; David Casarett; Krista Haines; Mashael Al-Hegelan; Raquel R Bartz; Jason N Katz; Colleen Naglee; Deepshikha Ashana; Daniel Gilstrap; Jessie Gu; Alice Parish; Allie Frear; Deepthi Krishnamaneni; Andrew Corcoran; Sharron L Docherty Journal: Contemp Clin Trials Date: 2020-09-29 Impact factor: 2.226
Authors: Jennifer B Seaman; Robert M Arnold; Praewpannarai Buddadhumaruk; Anne-Marie Shields; Rachel M Gustafson; Kristyn Felman; Wendy Newdick; Rachel SanPedro; Suzanne Mackenzie; Jennifer Q Morse; Chung-Chou H Chang; Mary Beth Happ; Mi-Kyung Song; Jeremy M Kahn; Charles F Reynolds; Derek C Angus; Seth Landefeld; Douglas B White Journal: Ann Am Thorac Soc Date: 2018-09