Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms*

被引：6

作者：

Cox, Christopher E. ^{[1
,2
]}

Gu, Jessie ^{[1
,2
]}

Ashana, Deepshikha Charan ^{[1
,2
]}

Pratt, Elias H. ^{[1
,2
]}

Haines, Krista ^{[2
,3
]}

Ma, Jessica ^{[4
,5
]}

Olsen, Maren K. ^{[6
,7
]}

Parish, Alice ^{[6
]}

Casarett, David ^{[8
]}

Al-Hegelan, Mashael S. ^{[1
]}

Naglee, Colleen ^{[9
,10
]}

Katz, Jason N. ^{[11
]}

O'Keefe, Yasmin Ali ^{[10
]}

Harrison, Robert W. ^{[11
]}

Riley, Isaretta L. ^{[1
,2
]}

Bermejo, Santos ^{[1
,2
]}

Dempsey, Katelyn ^{[1
,2
]}

Johnson, Kimberly S. ^{[5
,12
]}

Docherty, Sharron L. ^{[13
]}

机构：

[1] Duke Univ, Sch Med, Dept Med, Div Pulm & Crit Care Med, Durham, NC 27708 USA

[2] Duke Univ, Program Support People & Enhance Recovery ProSPER, Durham, NC 27708 USA

[3] Duke Univ, Dept Surg, Div Trauma & Crit Care & Acute Care Surg, Durham, NC USA

[4] Duke Univ, Duke Univ Sch Med, Dept Med, Div Gen Internal Med, Durham, NC USA

[5] Durham VA Healthcare Syst, Geriatr Res Educ & Clin Ctr, Durham, NC USA

[6] Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA

[7] Durham Vet Affairs Hlth Care Syst, Durham Ctr Innovat Accelerate Discovery & Practice, Durham, NC USA

[8] Duke Univ, Dept Med, Sect Palliat Care & Hosp Med, Durham, NC USA

[9] Duke Univ, Dept Anesthesiol, Durham, NC USA

[10] Duke Univ, Dept Neurol, Div Neurocrit Care, Durham, NC USA

[11] Duke Univ, Sch Med, Dept Med, Div Cardiol, Durham, NC USA

[12] Duke Univ, Sch Med, Dept Med, Div Geriatr, Durham, NC USA

[13] Duke Univ, Sch Nursing, Durham, NC USA

来源：

CRITICAL CARE MEDICINE | 2023年 / 51卷 / 01期

基金：

美国国家卫生研究院;

关键词：

care delivery models; clinical palliative care triggers; palliative care; palliative care needs; psychological distress; POSTTRAUMATIC-STRESS-DISORDER; CRITICAL ILLNESS SURVIVORS; UNIT; OUTCOMES; CONSULTATION; CAREGIVERS; DEPRESSION; SEVERITY;

D O I：

10.1097/CCM.0000000000005701

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：13 / 24

页数：12

共 36 条

[21] APACHE-II - A SEVERITY OF DISEASE CLASSIFICATION-SYSTEM [J].