Predictors of resilience and positive outcomes for patients with acute respiratory failure and their family members: an observational study to guide intervention development

急性呼吸衰竭患者及其家人的恢复力和积极结果的预测因素：指导干预措施开发的观察性研究

• 批准号: 9279238
• 负责人: Erin Kathryn Kross
• 金额: $ 57.6万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9279238
• 关键词: Acute respiratory failure; Address; Affect; Area; Behavioral; Caring; Characteristics; Coping Skills; Critical Illness; Data; Disease; Enrollment; Family; Family Characteristics; Family Process; Family member; Future; Goals; Growth; Health Status; Hospitals; Individual; Intensive Care Units; Interpersonal Relations; Intervention; Interview; Knowledge; Length of Stay; Life; Longitudinal cohort study; Malignant Neoplasms; Measures; Mechanical ventilation; Observational Study; Outcome; Participant; Patient Discharge; Patient-Focused Outcomes; Patients; Population; Process; Psychological adjustment; Quality of life; Research; Role; Self Perception; Shapes; Social support; Specific qualifier value; Stress; Surveys; Survivors; Time; Trauma; United States; anxiety symptoms; base; clinical care; demographics; depressive symptoms; experience; health care service utilization; improved; improved outcome; innovation; meetings; multidisciplinary; novel; patient subsets; post-traumatic stress; psychological symptom; psychosocial; public health relevance; resilience; survivorship; therapy development; traumatic event

 DESCRIPTION (provided by applicant): Acute respiratory failure requiring mechanical ventilation in an intensive care unit is common, affecting almost 800,000 people each year. With survival improving over time, research on quality of life among ICU survivors and their family members has become increasingly important. This research has primarily focused on the negative experiences of these survivors and their family members, including long-term symptoms of depression, anxiety and post-traumatic stress that occur in patient survivors and their family members. In cancer and trauma survivors, studies have shown that individuals may respond with psychological adaptations that enable them to experience positive change in the context of their illness. A better understanding of the factors that define and influence patient and family psychological adaptations to the experience of acute respiratory failure, as well as the association between these adaptations and patient and family outcomes such as quality of life, will provide a novel opportunity to develop interventions to improve outcomes for patients with acute respiratory failure and their family members. This application proposes to conduct a longitudinal cohort study of patients with acute respiratory failure and their family members to identify the contributing factors and outcomes associated with psychological adaptation including resilience, post-traumatic growth and benefit finding. We hypothesize that there will be characteristics of patients and family members, as well as processes of clinical care in the intensive care unit, that are associated with psychological adaptation after acute respiratory failure, and that enhanced psychological adaptation will be associated with improved long-term outcomes for both patients and their family members. The study aims to enroll 250 patients with acute respiratory failure and 250 family members, and will obtain in hospital assessments of demographics, psychosocial and behavioral characteristics of participants. Chart abstraction data will be used to record details of the patient's hospital stay. Patients and family members wil complete additional survey assessments 6 months after discharge. A subset of patients and family members will participate in in-depth qualitative interviews. The study had 3 specific aims: 1) To determine the patient characteristics that are associated with positive psychological adaptation in patient survivors of acute respiratory failure; 2) to determine the family characteristics and ICU processes of care that are associated with positive psychological adaptation in family members; and 3) to determine the association between patient and family psychological adaptation and patient and family long-term outcomes including quality of life, adverse psychological symptoms and healthcare utilization. This application offers an opportunity to expand the body of knowledge regarding patient and family quality of life after acute respiratory failure by identifying novel associations between psychosocial and behavioral characteristics, psychological adaptation, and long-term outcomes which will lead to development of interventions focused on improving outcomes for critically ill patients and their family members.

 描述（由申请人提供）：重症监护室中需要机械通气的急性呼吸衰竭很常见，每年影响近80万人。随着生存率的提高，ICU幸存者及其家属的生活质量研究变得越来越重要。这项研究主要集中在这些幸存者及其家庭成员的负面经历，包括患者幸存者及其家庭成员的抑郁，焦虑和创伤后应激反应的长期症状。在癌症和创伤幸存者中，研究表明，个人可能会对心理适应做出反应，使他们能够在疾病的背景下经历积极的变化。更好地了解定义和影响患者和家庭对急性呼吸衰竭经历的心理适应的因素，以及这些适应与患者和家庭结局（如生活质量）之间的关联，将为制定干预措施以改善急性呼吸衰竭患者及其家庭成员的结局提供新的机会。本申请建议对急性呼吸衰竭患者及其家属进行纵向队列研究，以确定与心理适应相关的影响因素和结果，包括复原力、创伤后成长和获益发现。我们假设，将有患者和家庭成员的特点，以及在重症监护室的临床护理过程，与急性呼吸衰竭后的心理适应，并增强心理适应将与改善长期预后的患者及其家庭成员。该研究旨在招募250名急性呼吸衰竭患者和250名家庭成员，并将获得参与者的人口统计学，心理社会和行为特征的医院评估。图表抽象数据将用于记录患者住院时间的详细信息。患者和家属将在出院后6个月完成额外的调查评估。一部分患者和家属将参加深入的定性访谈。本研究有3个具体目的：1）确定与急性呼吸衰竭患者幸存者积极心理适应相关的患者特征; 2）确定与家庭成员积极心理适应相关的家庭特征和ICU护理过程;（3）确定患者和家庭心理适应与患者和家庭长期结局（包括生活质量、不良心理症状和医疗利用）之间的关系。该应用程序提供了一个机会，通过确定心理社会和行为特征，心理适应和长期结局之间的新关联，扩展有关急性呼吸衰竭后患者和家庭生活质量的知识体系，这将导致制定重点改善危重患者及其家庭成员结局的干预措施。