Katrina E Hauschildt1, Claire Seigworth2, Lee A Kamphuis3, Catherine L Hough4, Marc Moss5, Joanne M McPeake6, Molly Harrod7, Theodore J Iwashyna8. 1. Katrina E. Hauschildt is an advanced fellow in health services research at the Veterans Affairs Center for Clinical Management Research and a research associate in the Pulmonary and Critical Care Division at the University of Michigan, Ann Arbor. 2. Claire Seigworth is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan. 3. Lee A. Kamphuis is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan. 4. Catherine L. Hough is a professor of medicine and chief of the Division of Pulmonary and Critical Care Medicine at the Oregon Health & Science University in Portland. 5. Marc Moss is the Roger S. Mitchell Professor of Medicine and division head of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado. 6. Joanne M. McPeake is a nurse consultant, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom, a senior honorary clinical lecturer at the University of Glasgow School of Medicine, Dentistry & Nursing, Glasgow, and a THIS Institute research fellow at the University of Cambridge. 7. Molly Harrod is research health science specialist at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, Michigan. 8. Theodore J. Iwashyna is the co-director of the research core at the Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, and the Alpheus W. Tucker, MD, Collegiate Professor of Internal Medicine at the University of Michigan, Ann Arbor.
Abstract
BACKGROUND: Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients' adaptations to these problems after hospitalization may identify opportunities to improve recovery. OBJECTIVES: To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS. METHODS: Semistructured interviews were conducted after hospitalization in patients with ARDS who had received mechanical ventilation. This was an ancillary study to a multicenter randomized controlled trial. Consecutive surviving patients who spoke English, consented to follow-up, and had been randomized between November 12, 2017, and April 5, 2018 were interviewed 9 to 16 months after that. RESULTS: Forty-six of 79 eligible patients (58%) participated (mean [range] age, 55 [20-84] years). All patients reported using strategies to address physical, emotional, or cognitive problems after hospitalization. For physical and cognitive problems, patients reported accommodative strategies for adapting to new disabilities and recuperative strategies for recovering previous ability. For emotional issues, no clear distinction between accommodative and recuperative strategies emerged. Social support and previous familiarity with the health care system helped patients generate and use many strategies. Thirty-one of 46 patients reported at least 1 persistent problem for which they had no acceptable adaptation. CONCLUSIONS: Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.
BACKGROUND: Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients' adaptations to these problems after hospitalization may identify opportunities to improve recovery. OBJECTIVES: To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS. METHODS: Semistructured interviews were conducted after hospitalization in patients with ARDS who had received mechanical ventilation. This was an ancillary study to a multicenter randomized controlled trial. Consecutive surviving patients who spoke English, consented to follow-up, and had been randomized between November 12, 2017, and April 5, 2018 were interviewed 9 to 16 months after that. RESULTS: Forty-six of 79 eligible patients (58%) participated (mean [range] age, 55 [20-84] years). All patients reported using strategies to address physical, emotional, or cognitive problems after hospitalization. For physical and cognitive problems, patients reported accommodative strategies for adapting to new disabilities and recuperative strategies for recovering previous ability. For emotional issues, no clear distinction between accommodative and recuperative strategies emerged. Social support and previous familiarity with the health care system helped patients generate and use many strategies. Thirty-one of 46 patients reported at least 1 persistent problem for which they had no acceptable adaptation. CONCLUSIONS: Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.
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