Prevalence and Impact of Traumatic Life Events among Black and White Family Members of Intensive Care Unit Patients.
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2025-11
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Rationale: Lifetime trauma is common and may affect interactions with the healthcare system. Objectives: To measure the prevalence of lifetime trauma and its association with family-clinician interpersonal outcomes in the intensive care unit (ICU). Methods: A cross-sectional study was conducted in nine ICUs in one urban and one suburban-rural health system. Participants were Black or White surrogate decision makers for mechanically ventilated patients. Independent variables were the number of lifetime traumatic events measured using the Life Stressor Checklist-Revised (LSC-R) and, secondarily and separately, discrimination-related traumatic stress symptoms. The primary outcome was family-reported conflict with ICU clinicians about treatment decisions. Secondary outcomes were family-reported quality of clinician communication and therapeutic alliance. Results: Among 141 family members (median age, 52.7 yr [interquartile range, 41.9-62.0 yr]; n = 100 women [70.9%]; n = 85 White [60.3%]; n = 56 Black [39.7%]), the median number of lifetime traumatic events was 6.0 (interquartile range, 4.0-9.0). Lifetime trauma was significantly but nonlinearly associated with family-clinician conflict (odds ratio [OR], 1.44 [95% confidence interval (CI), 1.09-1.90] for LSC-R scores of 0-7.5; OR, 0.75 [95% CI, 0.55-1.02] for LSC-R scores of 7.5-16; P = 0.03). Discrimination-related stress symptoms were also associated with conflict (OR, 1.04 [95% CI, 1.003-1.07]; P = 0.03). Interactions between the independent variables and family member race were not significant, suggesting the effects of lifetime trauma and discrimination-related traumatic stress on family-clinician conflict were similar for Black and White caregivers. Conclusions: Lifetime trauma is common among families of critically ill patients and is associated with negative experiences of critical care. Trauma-informed care may reduce family- clinician conflict and improve other measures of family experience.
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Ashana, Deepshikha Charan, Joanna L Hart, Kimberly S Johnson, Ernestine C Briggs, Alice Parish, Maren K Olsen, Jennie Jaggers, Greer A Tiver, et al. (2025). Prevalence and Impact of Traumatic Life Events among Black and White Family Members of Intensive Care Unit Patients. Annals of the American Thoracic Society, 22(11). pp. 1720–1728. 10.1513/annalsats.202411-1157oc Retrieved from https://hdl.handle.net/10161/34402.
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Deepshikha Ashana
Dr. Deepshikha Ashana's research focuses on understanding and addressing mechanisms of differences in serious illness care among underserved patients. She uses mixed methods to study epidemiologic trends in national health claims data and understand patient perspectives on serious illness care, with a particular focus on modifiable clinician and health system factors.
She received her undergraduate, medical, and business degrees from the University of Pennsylvania, before moving to Los Angeles to complete her internal medicine residency at the University of California, Los Angeles. She subsequently worked as a management consultant at McKinsey and Company where she gained experience in health system operations and change management. While completing a fellowship in pulmonary and critical care medicine at the University of Pennsylvania Health System, she received formal training in research methods through the Master of Science in Clinical Epidemiology program.
She is currently an Assistant Professor of Medicine in the Division of Pulmonary and Critical Care. She cares for patients in the Duke University Hospital medical intensive care unit and at Duke Health Center at Southpoint.
Dr. Ashana lives in Raleigh with her husband and son where they enjoy cooking, hiking, and watching international films.
Kimberly Sherell Johnson
Alice Parish
Education: Master of Science in Public Health, Biostatistics- Emory University Rollins School of Public Health.
Overview: Alice collaborates with researchers and clinicians with the Division of Gastroenterology on many observational studies using data from EHR as well as large national databases such as HCUP, UNOS, and Medicare 5% LDS. Additionally, Alice collaborates with the Division of Pulmonary on palliative care RCTs and various retrospective studies. Alice works with the Pharmacy residents on their PGY1 studies. In the past Alice has had the opportunity to work with investigators in Heart Center and Epicenter. Alice has experience working with zero inflated count outcomes, among many other statistical methodologies.
Maren Karine Olsen
Health services research, longitudinal data methods, missing data methods
Katherine Ramos
Christopher Ethan Cox
My work is conducted as a clinician, researcher, teacher, and administrator at Duke University. Currently, I am a Professor of Medicine with Tenure 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 digital technologies, health services research, behavioral and psychological concerns, communication improvement, and decision making support—all in the context of critical care and palliative medicine. I am very active in clinical trials as well. Our group is exceedingly, sincerely grateful for having been continuously funded by NIH since 2009. We cannot thank enough the patients, family members, and clinicians who have been included in our research over the years.
I am very active mentoring others. Not only is this a true joy, but also how I keep learning from others.
Key interests: Critical care, healthcare information technology, critical care echocardiography, mobile apps, AI
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