A pilot study of trained ICU doulas providing early psychological support to critically ill patients

Abstract

Background Over a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor. In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed. Methods Adult critically ill patients were recruited for this single-arm, prospective pilot study. These ICU patients received a positive suggestion intervention daily during their ICU stay in parallel with their medical treatment. The intervention was designed to be delivered over a minimum of two sessions. Feasibility was defined as intervention delivery on ≥ 70% of ICU days after patient enrollment. As a secondary analysis, psychometric questionnaires were compared to those of a historic control cohort of patients receiving standard care in the ICU using adjusted linear regression models. Results Of the 97 patients who received the intervention and were alive at the end of their ICU course, 54 were excluded from analyses mostly for having received only one session because of a short ICU length of stay of < 2 days, transitioning to comfort care or not wanting to answer the study questionnaires. Forty-three patients who completed 2 or more sessions of the positive therapeutic suggestion intervention provided by two trained ICU doulas received it for a median of 4 days (IQR 3, 5), with each session lasting for a median of 20 min (IQR 14, 25). The intervention was delivered on 71% of days, meeting our pre-determined feasibility goal. Compared to historical controls (N = 299), patients receiving the intervention had higher severity of illness and longer length of stay. When adjusted for baseline differences, patients both with and without mechanical ventilation who received the intervention scored lower on the Hospital Anxiety and Depression Scale (HADS)—Depression subscale. The intervention was also associated with reduced HADS-Anxiety subscale among ventilated patients. Conclusions Positive therapeutic suggestion delivered by ICU doulas is feasible in the ICU setting. A randomized trial is warranted to better delineate the role that positive suggestion and ICU doulas may play in ongoing interprofessional efforts to humanize critical care medicine. The study was registered on clinicaltrials.gov (NCT03736954) on 03/14/2018 prior to the first patient enrollment https://clinicaltrials.gov/ct2/show/NCT03736954?cond=ICU+Doulas+Providing+Psychological+Support&draw=2&rank=1.

Acute fatty liver of pregnancy causing multiple organ dysfunction syndrome in a Chinese intensive care unit

“…More than one‐third of critical illness survivors struggle with post‐intensive care syndrome following hospitalization, which is characterized by anxiety, depression, and cognitive and physical impairments. Many interventions have been reported to improve psychological outcomes, including ICU diaries, music therapy, nurse‐led consultations, nurse‐led preventive psychological intervention, and mindfulness training 11 . In this case, the patient appeared slightly anxious and nervous on the first day in the ICU, naturally worrying about her newborn and herself.…”

“…Many interventions have been reported to improve psychological outcomes, including ICU diaries, music therapy, nurse-led consultations, nurse-led preventive psychological intervention, and mindfulness training. 11 In this case, the patient appeared slightly anxious and nervous on the first day in the ICU, naturally worrying about her newborn and herself. Subsequently, the pain increased her anxiety.…”

More is less: Effect of ICF-based early progressive mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU

“…In addition, it has been suggested that the psychological status of critically ill patients might affect the treatment outcomes ( 18 , 19 ) and also considered that the surrounding physical environmental stimulation devices such as lights and alarms present in the ICU environment may further lead to psychological problems such as anxiety and fear ( 20 , 21 ). As a part of psychological support, positive encouragement during mobilization interventions and improvement of one's abilities by maintaining self-confidence to achieve a better recovery might play a key role in a patient's recovery ( 22 , 23 ). The ICF-based progressive mobilization protocol has not only included environmental adjustments like day/night alternating light adjustment and alarm tone size setting but also provided videos recorded by family members or out of patients' usual interest, which may influence the patient's psychological state.…”

The Doula Model in American Health Care in the 21st Century

“…Although the need for intensive care doulas was identified in 2017, 19 the need was intensified by the rapid deterioration of life for those facing COVID-19 as well as other serious illnesses. 20,21 A study was initiated specifically to provide early psychological support for the critically ill. Doulas were trained to respond to the specific needs of the critical care patient-to understand more about policies and procedures in this setting, to provide comfort and support through soothing conversation, and to explain what to expect and to take the time to address whatever concerns the patient had in support of the busy nurse: in other words, this intervention was created to humanize the critically ill experience. 20 Anxiety reduction was notable.…”