Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura

Meyers, Emma; McCurley, Jessica L.; Lester, Ethan G.; Jacobo, Michelle; Rosand, Jonathan; Vranceanu, Ana‐Maria

doi:10.1016/j.cbpra.2020.02.001

Cited by 19 publications

(19 citation statements)

References 57 publications

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“…The substantial deterioration in symptoms observed in MEUC is consistent with prior studies which show that emotional distress at hospitalization predicts future emotional distress in both patients and caregivers [10,16]. These findings underscore the need for proactive intervention for prevention of emotional sequelae that occur in the wake of stroke for dyads [30].…”

Section: Discussionsupporting

confidence: 86%

“…Next, we conducted 24 qualitative interviews with stroke dyads followed by three focus groups with nurses [15] to determine dyads' challenges associated with the stroke and subsequent hospitalization, perceptions of the proposed intervention targets, ways to best teach the proposed resiliency skills, interest in the intervention, and best modality for intervention delivery. We subsequently treated one stroke dyad with Recovering Together [30] and made refinements from lessons learned.…”

Section: Introductionmentioning

confidence: 99%

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Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Bannon

Lester

Gates

et al. 2020

Pilot Feasibility Stud

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138

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Background: A stroke is a sudden, life-altering event with potentially devastating consequences for survivors and their loved ones. Despite advances in endovascular and neurocritical care approaches to stroke treatment and recovery, there remains a considerable unmet need for interventions targeting the emotional impact of stroke for both patients and their informal caregivers. This is important because untreated emotional distress becomes chronic and negatively impacts quality of life in both patients and caregivers. Our team previously used mixed methods to iteratively develop a six-session modular dyadic intervention to prevent chronic emotional distress in patients with stroke and their informal caregivers called "Recovering Together" (RT) using feedback from dyads and the medical team. The aim of the current study is to test the feasibility of recruitment, acceptability of screening and randomization methods, acceptability of RT, satisfaction with RT, feasibility of the assessment process at all time points, and acceptability of outcome measures. Secondarily, we aimed to explore within-treatment effect sizes and change in clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTS). The larger goal was to strengthen methodological rigor before a subsequent efficacy trial. Methods: We conducted a feasibility randomized controlled trial to evaluate the RT intervention relative to minimally enhanced usual care (MEUC) in stroke patients admitted to a Neurosciences Intensive Care Unit (Neuro-ICU). Dyads were enrolled within 1 week of hospitalization if they met specific eligibility criteria. Assessments were done via paper and pencil at baseline, and electronically via REDCap or over the phone at post-intervention (approximately 6 weeks after baseline), and 3 months later. Assessments included demographics, resiliency intervention targets (mindfulness, coping, self-efficacy, and interpersonal bond), and emotional distress (depression, anxiety, and PTS). Primary outcomes were feasibility and acceptability markers. Secondary outcomes were depression, anxiety, PTS, mindfulness, coping, self-efficacy, and interpersonal bond.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Bannon

Lester

Gates

et al. 2020

Pilot Feasibility Stud

Self Cite

138

View full text Add to dashboard Cite

show abstract

“…It is essential that patients and caregivers alike are educated about the emotional and social aspects of stroke recovery and that loss beyond the physical is acknowledged. Recent findings from the development and pilot study of the program “Recovering Together,” a dyadic cognitive behavioral approach, indicate that programs targeting both the stroke survivor and caregiver after discharge and during recovery may have positive effects on resilience, coping, and emotional well-being ( 37 , 38 ).…”

Section: Discussionmentioning

confidence: 99%

Grief and Loss Associated With Stroke Recovery: A Qualitative Study of Stroke Survivors and Their Spousal Caregivers

Hughes

Cummings

2020

Journal of Patient Experience

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Despite a focus on physical and cognitive outcomes, stroke survivors are also impacted by emotional and mental health challenges. Additionally, their caregivers may experience decreased well-being due to increased burden and role adjustment. A small body of literature characterizes this experience as a form of grief and loss. This study seeks to explore experiences of grief and loss reported by stroke survivors and caregivers, using Holbrook’s 4-stage bereavement model. This cross-sectional, qualitative study was conducted among adult stroke survivors (n = 9) and their spousal caregivers (n = 5). Focus groups on experiences of recent hospitalizations and transitions home were transcribed, coded, and thematic analysis was conducted, identifying a major theme of loss. Data were reanalyzed guided by Holbrook’s model. Common themes were losses and changes experienced by patients/caregivers, disbelief, and lack of understanding. Subthemes of denial and confusion were present. Less prevalent themes were loss of existing support systems and silver lining. Stroke survivors and caregivers experienced a range of negative emotions, impacting behaviors, self-perception, roles, and social support. Awareness of these issues can improve practice with those affected by stroke.

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“…The level of patient involvement will depend on degree of neurologic impairment; for those with cognitive deficits, skills such as mindfulness meditation can be emphasized. Early dyadic interventions starting at hospitalization and focusing on skills such as resiliency and interpersonal communication are underway in some institutions, including Massachusetts General Hospital's "Recovering Together" initiative [136], which was developed through qualitative feedback from dyads and nurses [104]. Pilot data show good feasibility and improvement in emotional distress and resiliency, with a subsequent single-blind randomized controlled trial funded by the National Institute of Nursing Research underway.…”

Section: Discussionmentioning

confidence: 99%

Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit

2019

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Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.

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Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura

Cited by 19 publications

References 57 publications

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Grief and Loss Associated With Stroke Recovery: A Qualitative Study of Stroke Survivors and Their Spousal Caregivers

Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit

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