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Using data from online surveys, Rolfsen and <\/b>colleagues evaluated responses from 382 ICU health care providers at nine U.S. institutions (six academic, one nonacademic and two mixed academic and nonacademic) and 146 patients (median age, 56 years; 47.9% female; 93.8% white) who recently survived critical illness to determine the awareness level of post-intensive care syndrome (PICS) in both groups.<\/p>\n
\u201cThere is plenty of research on PICS and long-term outcomes after critical illness, but whether this is actually being told to patients\/families outside of research encounters was not well studied,\u201d Rolfsen said.<\/p>\n
Population characteristics<\/h2>\n Among the surveyed ICU providers, most were registered nurses (RNs; 53.7%), followed by attending physicians (23.6%), advanced practice providers (APPs; 13.4%) and fellows (9.4%).<\/p>\n
The surgical ICU and cardiovascular ICU were where the majority of ICU survivors surveyed had their most recent admission (each 41.1%). Fewer patients had been admitted to a medical ICU (14.4%), cardiac ICU (2.7%) and trauma ICU (0.7%).<\/p>\n
Results<\/h2>\n When asked if they had previously heard the term \u201cpost-intensive care syndrome,\u201d 73.8% of providers had an affirmative response, whereas a smaller proportion of patients (16.6%) said they remembered being told the term, according to the study.<\/p>\n
Notably, when broken down by provider role, researchers found that fellows and attending physicians had the highest proportion of individuals who heard the term (97.6%) while RNs had the lowest proportion (56%).<\/p>\n
\u201cWe found that, despite sampling academic centers where PICS might be more discussed, only about half of bedside nurses had heard of the term,\u201d Rolfsen told Healio. \u201cWe believe that improving nursing awareness of PICS and equipping them with the tools and confidence to discuss these possible outcomes with patients or families would be a valuable endeavor.\u201d<\/p>\n
In terms of provider confidence in communicating the likeliness of having new\/worsening impairments after critical illness to patients and families, less than one-third (31.7%; RNs, 29.9%; APPs, 28%; fellows and attendings, 36%) said they felt \u201cgood\u201d or \u201cexcellent.\u201d<\/p>\n
Additionally, the frequency of discussions with patients\/families on the possibility of any new\/worsening impairments after critical illness was low. With the context of \u201ca patient who required mechanical ventilation and vasopressors with several days of delirium and who was expected to return home and potentially to full employment,\u201d 29.9% of providers indicated that they would have this discussion with the patient\/family more than one-half of the time. <\/p>\n
On the patient side, researchers found that 35.6% reported remembering being told about the possibility of not returning to the same baseline function after critical illness.<\/p>\n
Taking a closer look at the three domains of PICS, the domain with the highest proportion of providers reporting that they communicate it at least half the time was the physical domain (55.4%), followed by the cognitive domain (24.6%) and the mental health domain (22.8%). <\/p>\n
Among patients, the domain with the highest proportion of individuals that remember being told about it was also the physical domain (40.3%), followed by the mental health domain (34.5%) and the cognitive domain (26.9%).<\/p>\n
Lastly, researchers highlighted that 45.2% of patients expressed being surprised at how challenging recovery from critical illness has been, and 58.2% wished there were more conversations about recovery prior to ICU discharge.<\/p>\n
\u201cFamilies are crucial in receiving information for their loved ones who might have poor recollection of the ICU or even hospital admission (a noted limitation of our study),\u201d Rolfsen told Healio. \u201cDetermining when and how to deliver information to families would be an important step forward. <\/p>\n
\u201cAdditionally, hospitalists are pivotal in improving this communication gap and we hope to collaborate with them to improve patient-centered outcomes,\u201d he said.<\/p>\n
For more information:<\/h2>\n Mark L. Rolfsen, MD<\/b>, MSCI<\/b>, <\/b>can be reached at mark.l.rolfsen@vumc.org. <\/p>\n\n
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Perspective<\/h2>\n Back to Top
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In this study, Rolfsen and colleagues <\/default:i>expose a frequently overlooked gap in ICU care. This discrepancy lies between provider awareness of PICS and meaningful communication with patients and caregivers about new or worsening impairments that may emerge or persist for months to years after critical illness. <\/default:p>In this study, nearly three-quarters of providers reported awareness of PICS, but only a small fraction of patients recalled being informed about it. Furthermore, fewer than one-third of providers reported they would discuss PICS with their patients at least half of the time and, when they do, providers are more likely to discuss physical health impairments rather than cognitive and mental health problems that are also prominent features of PICS. <\/default:p>This gap mirrors clinical reality, where time-pressured ICU environments often prioritize immediate survival over long-term recovery. Discussions about potential cognitive, physical and mental health problems may also be hampered by prognostic uncertainty, a factor identified by the researchers. <\/default:p>Yet, as this study demonstrates (albeit in a small sample), over half of patients experienced at least one domain of PICS, and many reported being surprised by difficulties experienced during recovery. Thus, these findings reflect a mismatch between patient expectations and actual outcomes, underscoring the importance of anticipatory guidance by the ICU care team. <\/default:p>Importantly, this study points to actionable opportunities for improving care. Integrating routine discussions of PICS into rounds, family meetings or transitions of care planning can normalize these conversations. Equally essential is establishing primary responsibility among team members, as nearly half of the surveyed providers reported no one currently \u201cowns\u201d this discussion. Expanding conversations with patients\u2019 relatives is also important as they are at risk for a related syndrome \u2014 PICS-Family. <\/default:p>How do we redefine \u201csuccess\u201d in the ICU to include post-discharge quality of life? <\/default:i>Larger studies evaluating the impact of structured communication strategies, optimal timing of discussions and methods to improve patient and family comprehension and retention are needed. Ultimately, preparing patients and families for survivorship should be viewed not as optional, but as a fundamental component of high-quality ICU care.<\/default:p><\/p>\n\n
Margo A. Halm, PhD, RN, NEA-BC, FAAN<\/strong><\/p>\n\nNurse Scientist Consultant, Portland, Oregon<\/li>\n<\/ul><\/div>\n
Disclosures: <\/strong> Halm reports no relevant financial disclosures.
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