Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.
Date
2022-03
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Abstract
Symptoms of posttraumatic stress disorder (PTSD) are common among surrogate decision makers of patients with chronic critical illness (CCI). PTSD symptoms can be categorized into clusters including intrusion, avoidance, and hyperarousal, each of which has been associated with distinct outcomes and treatment responses. Our objective was to determine which symptom cluster was predominant among surrogates of patients with CCI.
Design
Secondary analysis of data from a clinical trial of a communication intervention.Setting
The original trial was conducted in medical intensive care units at three tertiary-care centers and one community hospital.Patients
Patients with CCI (≥7 d of mechanical ventilation and not expected to die or to be weaned from the ventilator in the subsequent 72 hr) and their surrogates.Interventions
None.Measurements and main results
Surrogate PTSD symptoms were measured 90 days after onset of patient CCI using the Impact of Events Scale-Revised (IES-R). The IES-R includes a total score (range, 0-88, higher scores indicate severe symptoms) as well as three subscales that assess intrusion, avoidance, and hyperarousal (range of intrusion and avoidance scores 0-32 and range of hyperarousal score 0-24). Intrusion symptoms were most severe (mean score, 10.3; 95% CI, 9.3-11.2), followed by avoidance (mean score, 8.0; 95% CI, 7.2-8.8). Hyperarousal symptoms were lowest (mean score, 5.1; 95% CI, 4.5-5.7). In a multivariable linear regression model, we found that surrogates of patients who died had higher odds of intrusion (β, 5.52; p < 0.0001) and avoidance (β, 3.29; p = 0.001) symptoms than surrogates of patients who lived, even after adjusting for baseline symptoms of anxiety and depression. Patient death was not associated with hyperarousal symptoms.Conclusions
Intrusive thoughts are the most severe PTSD symptom in surrogates of patients experiencing CCI, with intensified symptoms among surrogates of patients who died. These results have the potential to inform tailored treatment strategies to reduce PTSD symptoms in this population.Type
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Wendlandt, Blair, Agathe Ceppe, Bradley N Gaynes, Christopher E Cox, Laura C Hanson, Judith E Nelson and Shannon S Carson (2022). Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness. Critical care explorations, 4(3). p. e0647. 10.1097/cce.0000000000000647 Retrieved from https://hdl.handle.net/10161/24750.
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Christopher Ethan Cox
My work is conducted as a clinician, researcher, teacher, and administrator at Duke University. Currently, I am an Associate Professor of Medicine, the director of Duke’s Medical Intensive Care Unit (MICU), and the Director of the Duke Program to Support People and Enhance Recovery (ProSPER). My clinical work is based in ICUs at Duke University, though I am also a board-certified palliative medicine specialist.
My research focuses on understanding and improving the experience of critical illness and quality of care for patients, their families and loved ones, clinicians, and society in general. To do this, my work addresses topics and methodologies including health services research, behavioral and psychological concerns, communication improvement, technological development, and decision making support—all in the context of critical care and palliative medicine. My extensive training in clinical and health services research methodology and healthcare information technology allows me to do this.
Key interests: Critical care, healthcare information technology, health administration and policy, decision making, health economics, mechanical ventilation, palliative care, chronic critical illness / prolonged mechanical ventilation, critical care echocardiography
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