Background Necrotizing Soft Tissue Infections (NSTIs) represent a devastating spectrum of disease with high case-mortality and resource intensive care. Treatment consists of wide surgical debridement and often prolonged periods of ICU care. Major complications are common. The severity of the disease and the aggressive treatment requirements put survivors at risk for significant long-term sequelae related to the trauma of both disease and treatment. Information about the post-discharge impact of NSTIs on survivors is extremely limited. Qualitative approaches are typically used to explore new phenomena and to capture individuals' thoughts, feelings, or intepretations of meaning and process. Therefore, qualitative methods are ideally suited for hypothesis generation to guide future quantitative study and ensure measured outcomes are patient-centered. Materials and Methods Semi-structured interviews were conducted with survivors of NSTIs from a single regional referral center. Stratified, purposive sampling was used to select interview candidates based on severity of illness. Descriptive thematic analysis was performed to identify major themes described by the patients. Results Interviews with 18 survivors identified 3 primary domains of experience: 1) individual factors, 2) relational factors, and 3) societal factors. These domains were split into two categories: factors effecting the disease process and recovery, and factors that were outcomes of the disease process. Each category yielded between one and seven themes. Themes identified included physical, psychological, relationship, and employment aspects. Conclusions Patient's reported quality of life was significantly affected by their disease and recovery. The results demonstrate that many outcomes of importance for patients are not easily assessed by traditional measures of outcomes. This work illustrates the multi-dimensional nature of recovery from critical illness, and show that it represents a massive transition period in the lives of survivors that affects the patient, their family, and the patient's ability to interact with society. Interviews with survivors ensure that the patient voice is heard prior to developing tools to assess long-term outcomes.
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