Health expectations after acute respiratory failure in survivor-care partner dyads

项目摘要 在美国，绝大多数患有急性呼吸衰竭（ARF）的成年人现在都能在住院治疗中存活下来， 临床进步的结果。许多ARF幸存者经历了新的和持续的身体，认知和精神 健康受损和>50%的幸存者在出院后1年仍依赖照顾者的帮助。 ARF患者的家庭/照顾者（“照顾伙伴”）也会出现精神健康症状和经济困难。 他们很难将自己的期望与ARF幸存者的康复协调起来。2015系统 回顾发现，23% - 29%的ICU幸存者的家庭照顾者1年内有持续的抑郁症状 出院后。这与痴呆症患者的照顾者的抑郁率相当， 明显高于美国成年人抑郁症的患病率。2020年系统性综述 11项随机对照试验测试了缓解危重病后家庭情绪困扰的干预措施，报告称，所有 试验失败了，这表明需要创新的方法。我们对急性呼吸衰竭幸存者的期望- 护理合作伙伴的二元关系影响行为和结果，是二元关系的可塑性和创新目标 应对干预（DCI）。然而，在开发DCI之前，需要进行必要的研究， 了解ARF后对恢复的期望是如何形成的，以及它们如何影响心理健康 ARF幸存者-护理伙伴二人组的应对行为。我们假设，当ARF生存-护理 伴侣对管理新的护理需求的共同能力缺乏信心（即自我效能低） 对恢复的期望影响心理健康和二元应对。总体 本申请的目的是了解对ARF生存率的期望与二元心理 健康症状和二元应对（目标1和2），并了解对ARF恢复的期望是如何 随着时间的推移，在幸存者-护理伙伴二人组中形成和塑造（目标3）。为达致上述目标，我们 提出一个混合方法的研究方案。首先，我们将对235对患者进行纵向队列研究， 来自4家医院的成人急性呼吸衰竭幸存者和护理伙伴（目标1和2）。在第三个目标中，我们将进行半 结构化访谈与≥36个目标1的二分之一，分为最大变异样本的二分之一， 对恢复的预期：a）改善，B）恶化，c）在二元组成员之间差异很大。我们将 我还探讨了如何处理二元应对和健康管理，以确定潜在的差距， 可以通过干预来改变。这项工作将为发展二元应对提供必要的信息 专门针对ARF生存挑战的干预措施。

PROJECT SUMMARY The vast majority of adults with Acute Respiratory Failure (ARF) in the U.S. now survive hospitalization as a result of clinical advances. Many ARF survivors experience new and persistent physical, cognitive, and mental health impairments and >50% of survivors remain dependent on caregiver assistance 1 year after discharge. Family/caregivers (“care partners”) of ARF patients also experience mental health symptoms and financial stress, and have difficulty reconciling their expectations with ARF survivors’ recovery. A 2015 systematic review found persistent symptoms of depression in 23% - 29% of family caregivers of ICU survivors 1 year after discharge. This is comparable to rates of depression in caregivers for people with dementia and significantly higher than the prevalence of depression in the U.S. adult population. A 2020 systematic review of 11 RCTs testing interventions to mitigate family emotional distress following critical illness reported that all trials had failed, suggesting a need for innovative approaches. We posit that expectations within ARF survivor- care partner dyads influence behaviors and outcomes and are a malleable and innovative target for dyadic coping interventions (DCI). However, before DCI can be developed, essential research is required to understand how expectations about recovery are formed following ARF and how they impact the mental health and coping behaviors of ARF survivor-care partner dyads. We hypothesize that when ARF survivor-care partner dyads lack confidence in their shared ability to manage new care needs (i.e. low self-efficacy) expectations for recovery within a dyad influence both mental health and dyadic coping. The overarching objectives of this application are to learn how expectations about ARF survivorship are related to dyadic mental health symptoms and dyadic coping (Aims 1 & 2) and to understand how expectations about ARF recovery are formed and shaped over time within survivor-care partner dyads (Aim 3). To achieve the above objectives, we propose a mixed methods research program. First, we will conduct a longitudinal cohort study of 235 dyads of adult ARF survivors and care partners from 4 hospitals (Aims 1 & 2). Thereafter in Aim 3, we will conduct semi- structured interviews with ≥36 Aim 1 dyads divided across a maximum variation sample of dyads whose expectations for recovery: a) improved, b) worsened, c) differed substantially between dyad members. We will also explore how dyads approach dyadic coping and health management to identify gaps that are potentially modifiable with intervention. The proposed work will provide essential information for developing dyadic coping interventions specifically tailored to the challenges of ARF survivorship.