Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms*
Year: 2022
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: While palliative care needs are assumed to improve during ICU care, few empiric data exist on need trajectories or their impact on long-term outcomes. We aimed to describe trajectories of palliative care needs during ICU care and to determine if changes in needs over 1 week was associated with similar changes in psychological distress symptoms at 3 months. DESIGN: Prospective cohort study. SETTING: Six adult medical and surgical ICUs. PARTICIPANTS: Patients receiving mechanical ventilation for greater than or equal to 2 days and their family members. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the 13-item Needs at the End-of-Life Screening Tool (NEST; total score range 0-130) completed by family members at baseline, 3, and 7 days. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Post-Traumatic Stress Scale (PTSS) were completed at baseline and 3 months. General linear models were used to estimate differences in distress symptoms by change in need (NEST improvement ≥ 10 points or not). One-hundred fifty-nine family members participated (median age, 54.0 yr [interquartile range (IQR), 44.0-63.0 yr], 125 [78.6%] female, 54 [34.0%] African American). At 7 days, 53 (33%) a serious level of overall need and 35 (22%) ranked greater than or equal to 1 individual need at the highest severity level. NEST scores improved greater than or equal to 10 points in only 47 (30%). Median NEST scores were 22 (IQR, 12-40) at baseline and 19 (IQR, 9-37) at 7 days (change, -2.0; IQR, -11.0 to 5.0; p = 0.12). There were no differences in PHQ-9, GAD-7, or PTSS change scores by change in NEST score (all p > 0.15). CONCLUSIONS: Serious palliative care needs were common and persistent among families during ICU care. Improvement in needs was not associated with less psychological distress at 3 months. Serious needs may be commonly underrecognized in current practice.
Source: Critical Care Medicine
Authors: Christopher E. Cox, Jessie Gu, Deepshikha Charan Ashana, Elias H. Pratt, Krista Haines, Jessica Ma, Maren K. Olsen, Alice Parish, David Casarett, Mashael S. Al-Hegelan, Colleen Naglee, Jason N. Katz, Yasmin Ali O’Keefe, Robert W. Harrison, Isaretta L. Riley, Santos Bermejo, Katelyn Dempsey, Kimberly S. Johnson, Sharron L. Docherty
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Duke Center for REsearch to AdvanCe Healthcare Equity (REACH EQUITY), Needs and triggers: improving intensive care unit-based palliative care delivery, PCplanner: operationalizing needs-focused palliative care for older adults in intensive, Coping with Asthma through Life Management (CALM), Duke Program of Training in Pulmonary ReSearch to Promote, Engage and Retain Academic Researchers (PROSPER)
OpenAlex ID: W4308057400