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The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness.

Publication ,  Journal Article
Wendlandt, B; Ceppe, A; Cox, CE; Hanson, LC; Nelson, JE; Carson, SS
Published in: Ann Am Thorac Soc
November 2021

Rationale: Surrogate decision-makers of patients with chronic critical illness (CCI) are at high risk for symptoms of post-traumatic stress disorder (PTSD). Whether patient health status after hospital discharge is a risk factor for surrogate PTSD symptoms is not known. Objectives: To determine the association between patient health status 90 days after the onset of CCI and surrogate symptoms of PTSD. Methods: We performed a secondary analysis of the data from a multicenter randomized trial of a communication intervention for adult patients with CCI and their surrogate decision-makers. Results: Surrogate PTSD symptoms were measured at 90 days using the Impact of Events Scale-Revised. For patients who were alive at 90 days, location was used as a marker of health status and included the following categories: 1) home (relatively good health and low acuity), 2) acute rehabilitation (moderate care needs and impairments, generally expected to improve), 3) skilled nursing facility (moderate care needs and impairments, generally not expected to improve significantly or quickly), 4) long-term acute care facility (persistently high acute care needs and functional impairment), and 5) readmission to an acute care hospital (suggesting the highest acuity of illness and care needs of the cohort). Patients who died before 90 days were categorized as deceased. In the analyses, 365 surrogates and 256 patients were included. Among patients, 49% were female, and the mean age was 59 years. Among surrogates, 71% were female, and the mean age was 51 years. A directed acyclic graph was constructed to identify covariates to be included in the model. Compared with symptoms seen among surrogates of patients living at home, heightened PTSD symptoms were seen among surrogates of patients who were readmitted to an acute care hospital (β coefficient, 15.9; 95% confidence interval [CI], 4.5 to 27.3) or had died (β coefficient, 14.8; 95% CI, 8.8 to 20.9) at 90 days. Conclusions: Surrogates of patients with CCI who have died or have been readmitted to an acute care hospital at 90 days experience increased PTSD symptoms as compared with surrogates of patients who are living at home. These patients and surrogates represent a readily identifiable group who may benefit from enhanced emotional support.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

November 2021

Volume

18

Issue

11

Start / End Page

1868 / 1875

Location

United States

Related Subject Headings

  • Stress Disorders, Post-Traumatic
  • Proxy
  • Middle Aged
  • Humans
  • Health Status
  • Female
  • Decision Making
  • Critical Illness
  • Adult
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wendlandt, B., Ceppe, A., Cox, C. E., Hanson, L. C., Nelson, J. E., & Carson, S. S. (2021). The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness. Ann Am Thorac Soc, 18(11), 1868–1875. https://doi.org/10.1513/AnnalsATS.202010-1300OC
Wendlandt, Blair, Agathe Ceppe, Christopher E. Cox, Laura C. Hanson, Judith E. Nelson, and Shannon S. Carson. “The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness.Ann Am Thorac Soc 18, no. 11 (November 2021): 1868–75. https://doi.org/10.1513/AnnalsATS.202010-1300OC.
Wendlandt B, Ceppe A, Cox CE, Hanson LC, Nelson JE, Carson SS. The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness. Ann Am Thorac Soc. 2021 Nov;18(11):1868–75.
Wendlandt, Blair, et al. “The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness.Ann Am Thorac Soc, vol. 18, no. 11, Nov. 2021, pp. 1868–75. Pubmed, doi:10.1513/AnnalsATS.202010-1300OC.
Wendlandt B, Ceppe A, Cox CE, Hanson LC, Nelson JE, Carson SS. The Association between Patient Health Status and Surrogate Decision Maker Post-Traumatic Stress Disorder Symptoms in Chronic Critical Illness. Ann Am Thorac Soc. 2021 Nov;18(11):1868–1875.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

November 2021

Volume

18

Issue

11

Start / End Page

1868 / 1875

Location

United States

Related Subject Headings

  • Stress Disorders, Post-Traumatic
  • Proxy
  • Middle Aged
  • Humans
  • Health Status
  • Female
  • Decision Making
  • Critical Illness
  • Adult
  • 3202 Clinical sciences