Anne Højager Nielsen1, Sanne Angel2, Ingrid Egerod3, Trine Højfeldt Lund4, Marianne Renberg5, Torben Bæk Hansen6. 1. Department of Anesthesiology, Regional Hospital Holstebro, Lægårdvej 12, 7500, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Incuba/Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark. Electronic address: annsve@rm.dk. 2. Section for Nursing, Department of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000, Aarhus C, Denmark. Electronic address: angel@ph.au.dk. 3. University of Copenhagen, Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Intensive Care Unit 4131, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Electronic address: ingrid.egerod@regionh.dk. 4. Intensive Care Unit, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: trinelun@rm.dk. 5. Recovery and Intensive Care Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Århus C, Denmark. Electronic address: marirenb@rm.dk. 6. University Clinic for Hand, Hip and Knee Surgery, Regional Hospital Holstebro, Aarhus University, Lægårdvej 12, 7500 Holstebro, Denmark. Electronic address: torbehns@rm.dk.
Abstract
BACKGROUND: Critical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial. OBJECTIVES: The objective of this study was to explore the effect of a diary authored by a close relative for a critically ill patient. METHODS: The study was a multicenter, block-randomised, single-blinded, controlled trial conducted at four medical-surgical ICUs at two university hospitals and two regional hospitals. Eligible for the study were patients ≥18 years of age, undergoing mechanical ventilation for ≥24 h, staying in the ICU ≥48 h, with a close relative ≥18 years of age. A total of 116 relatives and 75 patients consented to participate. Outcome measures were scores of posttraumatic stress symptoms, anxiety, depression, and health-related quality of life three months after ICU discharge. RESULTS: Relatives had 26.3% lower scores of posttraumatic stress in the diary group than in the control group (95% confidence interval: 4.8-% to 52.2%). Patients had 11.2% lower scores of posttraumatic stress symptoms in the diary group (95% confidence interval: -15.7% to 46.8%). There were no differences between groups in depression, anxiety, or health-related quality of life. CONCLUSION: A diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically ill patients during their stay in the ICU.
RCT Entities:
BACKGROUND:Critical illness and mechanical ventilation may cause patients and their relatives to experience symptoms of posttraumatic stress, anxiety, and depression due to fragmentation of memories of their intensive care unit (ICU) stay. Intensive care diaries authored by nurses may help patients and relatives process the experience and reduce psychological problems after hospital discharge; however, as patients particularly appreciate diary entries made by their relatives, involving relatives in authoring the diary could prove beneficial. OBJECTIVES: The objective of this study was to explore the effect of a diary authored by a close relative for a critically illpatient. METHODS: The study was a multicenter, block-randomised, single-blinded, controlled trial conducted at four medical-surgical ICUs at two university hospitals and two regional hospitals. Eligible for the study were patients ≥18 years of age, undergoing mechanical ventilation for ≥24 h, staying in the ICU ≥48 h, with a close relative ≥18 years of age. A total of 116 relatives and 75 patients consented to participate. Outcome measures were scores of posttraumatic stress symptoms, anxiety, depression, and health-related quality of life three months after ICU discharge. RESULTS: Relatives had 26.3% lower scores of posttraumatic stress in the diary group than in the control group (95% confidence interval: 4.8-% to 52.2%). Patients had 11.2% lower scores of posttraumatic stress symptoms in the diary group (95% confidence interval: -15.7% to 46.8%). There were no differences between groups in depression, anxiety, or health-related quality of life. CONCLUSION: A diary written by relatives for the ICU patient reduced the risk of posttraumatic stress symptoms in relatives. The diary had no effect on depression, anxiety, or health-related life quality. However, as the diary was well received by relatives and proved safe, the diary may be offered to relatives of critically illpatients during their stay in the ICU.
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