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

Publication ,  Journal Article
Cox, CE; Gu, J; Ashana, DC; Pratt, EH; Haines, K; Ma, J; Olsen, MK; Parish, A; Casarett, D; Al-Hegelan, MS; Naglee, C; Katz, JN; O'Keefe, YA ...
Published in: Critical care medicine
January 2023

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.Prospective cohort study.Six adult medical and surgical ICUs.Patients receiving mechanical ventilation for greater than or equal to 2 days and their family members.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).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.

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Published In

Critical care medicine

DOI

EISSN

1530-0293

ISSN

0090-3493

Publication Date

January 2023

Volume

51

Issue

1

Start / End Page

13 / 24

Related Subject Headings

  • Psychological Distress
  • Prospective Studies
  • Palliative Care
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
  • Female
  • Family
  • Emergency & Critical Care Medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Cox, C. E., Gu, J., Ashana, D. C., Pratt, E. H., Haines, K., Ma, J., … Docherty, S. L. (2023). Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms. Critical Care Medicine, 51(1), 13–24. https://doi.org/10.1097/ccm.0000000000005701
Cox, Christopher E., Jessie Gu, Deepshikha Charan Ashana, Elias H. Pratt, Krista Haines, Jessica Ma, Maren K. Olsen, et al. “Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms.Critical Care Medicine 51, no. 1 (January 2023): 13–24. https://doi.org/10.1097/ccm.0000000000005701.
Cox CE, Gu J, Ashana DC, Pratt EH, Haines K, Ma J, et al. Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms. Critical care medicine. 2023 Jan;51(1):13–24.
Cox, Christopher E., et al. “Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms.Critical Care Medicine, vol. 51, no. 1, Jan. 2023, pp. 13–24. Epmc, doi:10.1097/ccm.0000000000005701.
Cox CE, Gu J, Ashana DC, Pratt EH, Haines K, Ma J, Olsen MK, Parish A, Casarett D, Al-Hegelan MS, Naglee C, Katz JN, O’Keefe YA, Harrison RW, Riley IL, Bermejo S, Dempsey K, Johnson KS, Docherty SL. Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms. Critical care medicine. 2023 Jan;51(1):13–24.

Published In

Critical care medicine

DOI

EISSN

1530-0293

ISSN

0090-3493

Publication Date

January 2023

Volume

51

Issue

1

Start / End Page

13 / 24

Related Subject Headings

  • Psychological Distress
  • Prospective Studies
  • Palliative Care
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
  • Female
  • Family
  • Emergency & Critical Care Medicine