Older Adults' Perspectives on Screening for Cognitive Impairment Following Critical Illness: Pre-Implementation Qualitative Study.
Older Adults' Perspectives on Screening for Cognitive Impairment Following Critical Illness: Pre-Implementation Qualitative Study.
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DOI：
10.1097/cce.0000000000000920
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发表时间：
2023-05
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建议对ICU出院后的认知障碍进行筛查，但不是常规护理的一部分。我们试图了解老年人在ICU入院后对认知障碍筛查的看法，以便为认知筛查干预的设计和实施提供信息。定性研究采用半结构化访谈。在学术卫生系统中的ICU出院后3个月内60岁及以上的成年人。访谈是通过电话、录音和逐字转录进行的。所有的成绩单都是一式两份的编码。分歧以协商一致的方式解决。代码被归纳地组织成主题和子主题。我们完成了22次采访。参与者的平均年龄为71 ± 6岁，其中14名(63.6%)为男性，16名(72.7%)为白人，6名(27.3%)为黑人。主题分析围绕四个主题组织：1)接受筛选，2)沟通偏好，3)信息需求，4)提供者参与。大多数参与者接受认知筛查；这受到对提供者的信任以及先前的认知筛查和损伤经验的影响。参与者更喜欢简单、直接、富有同情心的交流。他们想要了解筛查程序、筛查的原理以及对康复的期望。参与者希望从他们的初级保健提供者那里获得信息，以便将他们的认知筛查结果放在他们整体健康的背景下，因为他们有值得信赖的关系，并且为了方便。参与者对认知筛查的理解和接触有限，但认为在ICU住院后有潜在的好处。供应商应该使用简单、直截了当的语言，并强调期望。可能需要资源来帮助初级保健提供者有能力为ICU幸存者提供认知筛查和解释结果。实施战略可以包括为临床医生和患者提供关于筛查和恢复预期的基本原理的教育材料。
Screening for cognitive impairment following ICU discharge is recommended but not part of routine care. We sought to understand older adults’ perspectives on screening for cognitive impairment following an ICU admission to inform the design and delivery of a cognitive screening intervention. Qualitative study using semi-structured interviews. Adults 60 years and older within 3 months of discharge from an ICU in an academic health system. Interviews were conducted via telephone, audio recorded and transcribed verbatim. All transcripts were coded in duplicate. Discrepancies were resolved by consensus. Codes were organized into themes and subthemes inductively. We completed 22 interviews. The mean age of participants was 71 ± 6 years, 14 (63.6%) were men, 16 (72.7%) were White, and 6 (27.3%) were Black. Thematic analysis was organized around four themes: 1) receptivity to screening, 2) communication preferences, 3) information needs, and 4) provider involvement. Most participants were receptive to cognitive screening; this was influenced by trust in their providers and prior experience with cognitive screening and impairment. Participants preferred simple, direct, compassionate communication. They wanted to understand the screening procedure, the rationale for screening, and expectations for recovery. Participants desired input from their primary care provider to have their cognitive screening results placed in the context of their overall health, because they had a trusted relationship, and for convenience. Participants demonstrated limited understanding of and exposure to cognitive screening but see it as potentially beneficial following an ICU stay. Providers should use simple, straightforward language and place emphasis on expectations. Resources may be needed to assist primary care providers with capacity to provide cognitive screening and interpret results for ICU survivors. Implementation strategies can include educational materials for clinicians and patients on rationale for screening and recovery expectations.