A pilot study of trained ICU doulas providing early psychological support to critically ill patients

Lioudmila V Karnatovskaia,Midhat Mujic,Katalin Varga,Brent A Bauer,Kemuel L Philbrick,Matthew M Clark,Ognjen Gajic,Phillip J Schulte,Alexander S Niven,Roberto P Benzo

doi:10.1186/s13054-021-03856-3

Lioudmila V Karnatovskaia, Midhat Mujic + Show 8 more

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https://doi.org/10.1186/s13054-021-03856-3

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Abstract

BackgroundOver a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor. In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed.MethodsAdult critically ill patients were recruited for this single-arm, prospective pilot study. These ICU patients received a positive suggestion intervention daily during their ICU stay in parallel with their medical treatment. The intervention was designed to be delivered over a minimum of two sessions. Feasibility was defined as intervention delivery on ≥ 70% of ICU days after patient enrollment. As a secondary analysis, psychometric questionnaires were compared to those of a historic control cohort of patients receiving standard care in the ICU using adjusted linear regression models.ResultsOf the 97 patients who received the intervention and were alive at the end of their ICU course, 54 were excluded from analyses mostly for having received only one session because of a short ICU length of stay of < 2 days, transitioning to comfort care or not wanting to answer the study questionnaires. Forty-three patients who completed 2 or more sessions of the positive therapeutic suggestion intervention provided by two trained ICU doulas received it for a median of 4 days (IQR 3, 5), with each session lasting for a median of 20 min (IQR 14, 25). The intervention was delivered on 71% of days, meeting our pre-determined feasibility goal. Compared to historical controls (N = 299), patients receiving the intervention had higher severity of illness and longer length of stay. When adjusted for baseline differences, patients both with and without mechanical ventilation who received the intervention scored lower on the Hospital Anxiety and Depression Scale (HADS)—Depression subscale. The intervention was also associated with reduced HADS-Anxiety subscale among ventilated patients.ConclusionsPositive therapeutic suggestion delivered by ICU doulas is feasible in the ICU setting. A randomized trial is warranted to better delineate the role that positive suggestion and ICU doulas may play in ongoing interprofessional efforts to humanize critical care medicine.The study was registered on clinicaltrials.gov (NCT03736954) on 03/14/2018 prior to the first patient enrollment https://clinicaltrials.gov/ct2/show/NCT03736954?cond=ICU+Doulas+Providing+Psychological+Support&draw=2&rank=1.

Highlights

Over a third of critical illness survivors suffer from mental health problems following hospitalization
Admission to the intensive care unit (ICU) can be a traumatic experience, and over a third of critical illness survivors struggle with post-intensive care syndrome or PICS following hospitalization characterized by symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) as well as cognitive and physical impairments [1,2,3,4,5]
Forty-three patients received the Psychological Support Based on Positive Suggestions (PSBPS) intervention provided by two trained ICU doulas for a median of 4 days (3, 5) with each session lasting a median of 20 min (14, 25)

Summary

Introduction

Over a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed. Admission to the intensive care unit (ICU) can be a traumatic experience, and over a third of critical illness survivors struggle with post-intensive care syndrome or PICS following hospitalization characterized by symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) as well as cognitive and physical impairments [1,2,3,4,5]. There are no published evidence-based interventions available to effectively prevent or treat mental health impairment in critical illness survivors. Memories of frightening and delusional experiences are a major potentially modifiable risk factor [1, 17]. Most conventional forms of psychotherapy require active patient participation, limiting their application during these early stages of fear memory formation

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