Psychological effects of remote-only communication among reference persons of ICU patients during COVID-19 pandemic

Jessy Cattelan, Sara Castellano, Hamid Merdji, Jean Audusseau, Baptiste Claude, Léa Feuillassier, Sibylle Cunat, Marc Astrié, Camille Aquin, Guillaume Buis, Edgar Gehant, Amandine Granier, Hassiba Kercha, Camille Le Guillou, Guillaume Martin, Kevin Roulot, Ferhat Meziani, Olivier Putois, Julie Helms, Jessy Cattelan, Sara Castellano, Hamid Merdji, Jean Audusseau, Baptiste Claude, Léa Feuillassier, Sibylle Cunat, Marc Astrié, Camille Aquin, Guillaume Buis, Edgar Gehant, Amandine Granier, Hassiba Kercha, Camille Le Guillou, Guillaume Martin, Kevin Roulot, Ferhat Meziani, Olivier Putois, Julie Helms

Abstract

Background: During COVID-19 pandemic, visits have been prohibited in most French ICUs. Psychological effects, for reference persons (RPs), of remote-only communication have been assessed.

Methods: All RPs of patients referred to ICU for COVID-19 were included. HADS, IES-R, and satisfaction were evaluated at admission, discharge/death, and 3 months. At 3 months, a psychologist provided a qualitative description of RPs' psychological distress.

Results: Eighty-eight RPs were included. Prevalence of anxiety and depression was 83% and 73% respectively. At 3 months, lower HADS decrease was associated with patient death/continued hospitalization, and/or sleeping disorders in RPs (p < 0.01). Ninety-nine percent RPs felt the patient was safe (9 [7; 10]/10 points, Likert-type scale), confident with caregivers (10 [9; 10]/10 points), and satisfied with information provided (10 [9; 10]/10 points). All RPs stressed the specific-type of "responsibility" associated with being an RP in a remote-only context, leading RPs to develop narrow diffusion strategies (67%) and restrict the array of contacted relatives to a very few and/or only contacting them rarely. 10 RPs (30%) related the situation to a prior traumatic experience.

Conclusion: RPs experienced psychological distress and reported that being an RP in a remote-only communication context was a specific responsibility and qualified it as an overall negative experience.

Trial registration: NCT04385121 . Registered 12 May 2020. https://clinicaltrials.gov/ .

Keywords: COVID-19; Reference person; Relative; Anxiety; Depression; Distress.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Anxiety and depression symptoms in reference persons at ICU admission and discharge. a Prevalence of anxiety and depression symptoms in reference persons (RPs) at ICU admission and discharge. b Evolution of total Hospital Anxiety and Depression Scale (HADS) between ICU admission and discharge in the 88 RPs, represented by whisker boxes (horizontal line inside the box: median, upper, and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively). c Evolution of the HAD anxiety and depression subscales between ICU admission and discharge in the 88 RPs. Scores of 8 points or more in each subscale were used for definite cases (gray dashed line) of anxiety and/or depression. Whisker boxes (horizontal line inside the box: median, upper and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively)
Fig. 2
Fig. 2
Sleep quality in reference persons at 3 months. Sleep quality was evaluated on a 10 points Likert-type scale at 3 months: 1 being a very bad quality of sleep and 10 a very good one
Fig. 3
Fig. 3
Evaluation of reference persons’ feelings at 3 months. Feelings of (i) safety, (ii) confidence in intensive care unit (ICU) caregivers, therapeutic decisions and information, (iii) satisfaction toward ICU care and information modalities, and (iv) comprehension of diagnosis, therapeutic, and prognosis during ICU stay. These were evaluated on a 10 points Likert-type scale at 3 months: 1 being a very bad feeling of security/confidence/satisfaction/comprehension and 10 a very good one
Fig. 4
Fig. 4
Anxiety and depression symptoms in reference persons at ICU admission, discharge and at 3 months. Hospital Anxiety and Depression Scale (HADS) evolution between admission, discharge/death, and 3 months later, in 33 RPs, represented by whisker boxes (horizontal line inside the box: median, upper and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively)
Fig. 5
Fig. 5
Post-traumatic stress disorder in reference persons at 3 months. a Impact of Event Scale-revised (IES-R) represented by whisker boxes (horizontal line inside the box: median, upper, and lower boxes: limits 25–75th percentiles and T-bars: 10–90th percentiles, respectively). Scores exceeding 32 points (dashed line) on IES-R scale were considered as indicating a PTSD. b Prevalence of post-traumatic Stress Disorder (PTSD) in reference persons (RPs) at 3 months

References

    1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) - Coronvirus Ressource Center. .
    1. Phua J, Weng L, Ling L, Egi M, Lim CM, Divatia JV, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8(5):506–517.
    1. Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017;45(1):103–128.
    1. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, et al. A communication strategy and brochure for relatives of patients dying in the ICU. New Engl J Med. 2007;356(5):469–478.
    1. Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med. 2012;40(2):618–624.
    1. Adelman RD, Tmanova LL, Delgado D, Dion S, Lachs MS. Caregiver burden: a clinical review. Jama. 2014;311(10):1052–1060.
    1. Garrouste-Orgeas M, Philippart F, Timsit JF, Diaw F, Willems V, Tabah A, et al. Perceptions of a 24-hour visiting policy in the intensive care unit. Crit Care Med. 2008;36(1):30–35.
    1. TSP I. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. Jama. 1995;274(20):1591–1598.
    1. Kose I, Zincircioglu C, Ozturk YK, Cakmak M, Guldogan EA, Demir HF, et al. Factors affecting anxiety and depression symptoms in relatives of intensive care unit patients. J Intensive Care Med. 2016;31(9):611–617.
    1. Garrouste-Orgeas M, Vinatier I, Tabah A, Misset B, Timsit JF. Reappraisal of visiting policies and procedures of patient's family information in 188 French ICUs: a report of the Outcomerea Research Group. Ann Intensive Care. 2016;6(1):82.
    1. Rosa RG, Tonietto TF, da Silva DB, Gutierres FA, Ascoli AM, Madeira LC, et al. Effectiveness and safety of an extended ICU visitation model for delirium prevention: a before and after study. Crit Care Med. 2017;45(10):1660–1667.
    1. Quenot JP, Meunier-Beillard N, Ksiazek E, Abdulmalak C, Berrichi S, Devilliers H, et al. Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU. J Crit Care. 2020;57:191–196.
    1. Rigaud JP, Hardy JB, Meunier-Beillard N, Devilliers H, Ecarnot F, Quesnel C, et al. The concept of a surrogate is ill adapted to intensive care: criteria for recognizing a reference person. J Crit Care. 2016;32:89–92.
    1. Akgun KM, Shamas TL, Feder SL, Schulman-Green D. Communication strategies to mitigate fear and suffering among COVID-19 patients isolated in the ICU and their families. Heart Lung. 2020;49(4):344–345.
    1. Montauk TR, Kuhl EA. COVID-related family separation and trauma in the intensive care unit. Psychol Trauma. 2020;12(S1):S96–SS7.
    1. Lissoni B, Del Negro S, Brioschi P, Casella G, Fontana I, Bruni C, et al. Promoting resilience in the acute phase of the COVID-19 pandemic: Psychological interventions for intensive care unit (ICU) clinicians and family members. Psychol Trauma. 2020;12(S1):S105–S1S7.
    1. White DB, Angus DC, Shields AM, Buddadhumaruk P, Pidro C, Paner C, et al. A Randomized trial of a family-support intervention in intensive care units. New Engl J Med. 2018;378(25):2365–2375.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370.
    1. Weiss D, Marmar C. The impact of event scale–revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD. New York: Guilford Press; 1997. pp. 399–411.
    1. Garrouste-Orgeas M, Flahault C, Vinatier I, Rigaud JP, Thieulot-Rolin N, Mercier E, et al. Effect of an ICU diary on posttraumatic stress disorder symptoms among patients receiving mechanical ventilation: a randomized clinical trial. Jama. 2019;322(3):229–239.
    1. Kalfon P, Alessandrini M, Boucekine M, Renoult S, Geantot MA, Deparis-Dusautois S, et al. Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year. Intensive Care Med. 2019;45(2):223–235.
    1. Kentish-Barnes N, Chevret S, Champigneulle B, Thirion M, Souppart V, Gilbert M, et al. Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial. Intensive Care Med. 2017;43(4):473–484.
    1. McAdam JL, Arai S, Puntillo KA. Unrecognized contributions of families in the intensive care unit. Intensive Care Med. 2008;34(6):1097–1101.
    1. Kentish-Barnes N, McAdam JL, Kouki S, Cohen-Solal Z, Chaize M, Galon M, et al. Research participation for bereaved family members: experience and insights from a qualitative study. Crit Care Med. 2015;43(9):1839–1845.
    1. Murphy MR, Escamilla MI, Blackwell PH, Lucke KT, Miner-Williams D, Shaw V, et al. Assessment of caregivers' willingness to participate in an intervention research study. Res Nurs Health. 2007;30(3):347–355.
    1. Pratt LA, Brody DJ. Depression in the U.S. household population, 2009-2012. NCHS Data Brief. 2014;(172):1–8.
    1. Morris SE, Moment A, Thomas JD. Caring for bereaved family members during the COVID-19 pandemic: before and after the death of a patient. J Pain Symptom Manage. 2020;60(2):e70–ee4.
    1. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005;171(9):987–994.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться