What is the mechanism effect that links social support to coping and psychological outcome within individuals affected by prostate cancer? Real time data collection using mobile technology

Abstract Unmet support needs are prevalent in men affected by prostate cancer. Moreover, little is known about the optimal type of social support, or its mechanism effect between coping and emotional outcome in men affected by this disease to identify areas for clinical intervention. This study aimed to empirically test the propositions of social support theory in “real time” within individual men living with and beyond prostate cancer. Purposeful sub-sample from a larger prospective longitudinal study of prostate cancer survivors, took part in real time data collection using mobile technology. Self-reports were collected for 31 days prompted by an audio alarm 3 times per day (a total of 93 data entries) for each of the 12 case studies. Electronic data were analysed using time series analysis. Majority of response rates were >90%. Men reported a lack of satisfaction with their support over time. Testing the propositions of social support theory “within individuals” over time demonstrated different results for main effect, moderation and mediation pathways that linked coping and social support to emotional outcome. For two men, negative effects of social support were identified. For six men the propositions of social support theory did not hold considering their within-person data. This innovative study is one of the first, to demonstrate the acceptability of e-health technology in an ageing population of men affected by prostate cancer. Collectively, the case series provided mixed support for the propositions of social support theory, and demonstrates that “one size does not fit all”

Polypharmacy and emergency readmission to hospital after critical illness:a population-level cohort study

From PubMed via Jisc Publications RouterPolypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.126pubpub

The use of diaries in psychological recovery from intensive care

Intensive care patients frequently experience memory loss, nightmares, and delusional memories and some may develop symptoms of anxiety, depression, and post-traumatic stress. The use of diaries is emerging as a putative tool to 'fill the memory gaps' and promote psychological recovery. In this review, we critically analyze the available literature regarding the use and impact of diaries for intensive care patients specifically to examine the impact of diaries on intensive care patients' recovery. Diversity of practice in regard to the structure, content, and process elements of diaries for intensive care patients exists and emphasizes the lack of an underpinning psychological conceptualization. The use of diaries as an intervention to aid psychological recovery in intensive care patients has been examined in 11 studies, including two randomized controlled trials. Inconsistencies exist in sample characteristics, study outcomes, study methods, and the diary intervention itself, limiting the amount of comparison that is possible between studies. Measurement of the impact of the diary intervention on patient outcomes has been limited in both scope and time frame. Furthermore, an underpinning conceptualization or rationale for diaries as an intervention has not been articulated or tested. Given these significant limitations, although findings tend to be positive, implementation as routine clinical practice should not occur until a body of evidence is developed to inform methodological considerations and confirm proposed benefits

Work-related stress:The impact of COVID-19 on critical care and redeployed nurses: A mixed-methods study

Lisa Salisbury - ORCID: 0000-0002-1400-3224 https://orcid.org/0000-0002-1400-3224Replaced AM with VoR 2021-07-08.Introduction: We need to understand the impact of COVID-19 on Critical Care (CCNs) and redeployed nurses and NHS organisations. Methods and analysis: This is a mixed methods study (QUANT – QUAL), underpinned by a theoretical model of occupational stress, the Job-Demand Resources Model (JD-R). Participants are critical care and redeployed nurses from Scottish and three large English units. Phase one is a cross-sectional survey in part replicating a pre-COVID-19 study and results will be compared with this data. Linear and logistic regression analysis will examine the relationship between antecedent, demographic, and professional variables on health impairment (burnout syndrome, mental health, posttraumatic stress symptoms), motivation (work engagement, commitment), and organisational outcomes (intention to remain in critical care nursing and quality of care). We will also assess the usefulness of a range of resources provided by the NHS and professional organisations. To allow in-depth exploration of individual experiences, phase two will be one-to-one semi-structured interviews with 25 CCNs and 10 redeployed nurses. The JD-R model will provide the initial coding framework to which the interview data will be mapped. The remaining content will be analysed inductively to identify and chart content that is not captured by the model. In this way the adequacy of the JD-R model is examined robustly and its expression in this context will be detailed. Ethics and dissemination: Ethics approval was granted from the University of Aberdeen CERB2020101993. We plan to disseminate findings at stakeholder events, publish in peer reviewed journals and at present at national and international conferences.https://doi.org/10.1136/bmjopen-2021-05132611pubpub

‘Intensive care unit survivorship’ - a constructivist grounded theory of surviving critical illness

Aims & objectiveTo theorise ICU survivorship after a critical illness based on longitudinal qualitative data.BackgroundIncreasingly patients survive episodes of critical illness. However, the short and long term impact of critical illness include physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives post-discharge with the term ‘Survivorship’ being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored.DesignLongitudinal-qualitative and constructivist Grounded Theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) 4-6 weeks post-discharge, (3) 6 months and (4) 12 months post-discharge across two adult intensive care setting.MethodIndividual face-to-face interviews. Data analysis followed the principles of Charmaz's Constructivist Grounded Theory. ‘ICU survivorship’ emerged as the core category and was theorised using concepts such as Status Passages, Liminality and Temporality to understand the various transitions participants made post-critical illness.FindingsIntensive care survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life post-critical illness. Surviving critical illness goes beyond recovery; surviving means ‘moving on’ to life post-critical illness. ‘Moving on’ incorporates a re-definition of self that incorporates any lingering intensive care legacies and being in control of one's life again.Relevance to clinical practiceFor healthcare professionals and policy makers it is important to realise that recovery and transitioning through to survivorship happens within an individual's time frame, not a schedule imposed by the healthcare system. Currently there are no care pathways or policies in place for critical illness survivors that would support ICU survivors and their families in the transitions to survivorship

A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventionsthroughout the recovery process.Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database(study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups

Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial

Objectives To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness.Design Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers.Setting Two university-affiliated hospitals in Scotland.Participants 240 patients discharged from ICU who required ?48?hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age 3?months postrandomisation.Interventions A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care.Outcome measures A novel PEQ capturing patient-reported aspects of quality care.Results The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (

PReventing early unplanned hOspital readmission aFter critical ILlnEss (PROFILE): protocol and analysis framework for a mixed methods study

Introduction Survivors of critical illness experience multidimensional disabilities that reduce quality of life, and 25–30% require unplanned hospital readmission within 3 months following index hospitalisation. We aim to understand factors associated with unplanned readmission; develop a risk model to identify intensive care unit (ICU) survivors at highest readmission risk; understand the modifiable and non-modifiable readmission drivers; and develop a risk assessment tool for identifying patients and areas for early intervention. Methods and analysis We will use mixed methods with concurrent data collection. Quantitative data will comprise linked healthcare records for adult Scottish residents requiring ICU admission (1 January 2000–31 December 2013) who survived to hospital discharge. The outcome will be unplanned emergency readmission within 90 days of index hospital discharge. Exposures will include pre-ICU demographic data, comorbidities and health status, and critical illness variables representing illness severity. Regression analyses will be used to identify factors associated with increased readmission risk, and to develop and validate a risk prediction model. Qualitative data will comprise recorded/transcribed interviews with up to 60 patients and carers recently experiencing unplanned readmissions in three health board regions. A deductive and inductive thematic analysis will be used to identify factors contributing to readmissions and how they may interact. Through iterative triangulation of quantitative and qualitative data, we will develop a construct/taxonomy that captures reasons and drivers for unplanned readmission. We will validate and further refine this in focus groups with patients/carers who experienced readmissions in six Scottish health board regions, and in consultation with an independent expert group. A tool will be developed to screen for ICU survivors at risk of readmission and inform anticipatory interventions

Predicting risk of unplanned hospital readmission in survivors of critical illness: a population-level cohort study

BackgroundIntensive care unit survivors experience high levels of morbidity after hospital discharge and are at high risk of unplanned hospital readmission. Identifying those at highest-risk before hospital discharge may allow targeting of novel risk reduction strategies. We aimed to identify risk factors for unplanned 90-day readmission, develop a risk prediction model and assess its performance to screen for ICU survivors at highest readmission risk.MethodsPopulation cohort study linking registry data for patients discharged from general ICUs in Scotland (2005-2013). Independent risk factors for 90-day readmission and discriminant ability (c-index) of groups of variables were identified using multivariable logistic regression. Derivation and validation risk prediction models were constructed using a time-based split.ResultsOf 55,975 ICU survivors, 24.1% (95%CI 23.7%,24.4%) had unplanned 90-day readmission. Pre-existing health factors were fair discriminators of readmission (c-index 0.63,95%CI 0.63,0.64), but better than acute illness factors (0.60) or demographics (0.54). In a subgroup of those with no comorbidity, acute illness factors (0.62) were better discriminators than pre-existing health factors (0.56). Overall model performance and calibration in the validation cohort was fair (0.65,95%CI 0.64,0.66) but did not perform sufficiently well as a screening tool, demonstrating high false positive/false negative rates at clinically relevant thresholds.ConclusionsUnplanned 90-day hospital readmission is common. Pre-existing illness indices are better predictors of readmission than acute illness factors. Identifying additional patient-centred drivers of readmission may improve risk prediction models. Improved understanding of risk factors that are amenable to intervention could improve the clinical and cost-effectiveness of post-ICU care and rehabilitation