Megan M. Hosey

IMPORTANCE: Many acute respiratory failure (ARF) survivors develop psychiatric sequelae. Inpatient psychologic distress is an important risk factor. OBJECTIVES: Evaluate ARF survivors’ perspectives on patient-centered communication and its relationship to the inpatient psychologic experience. DESIGN, SETTING, AND PARTICIPANTS: A mixed methods prospective observational study involving one survey and a semi-structured interview administered within 6 weeks of discharge to ARF survivors from two hospitals in the same system (August 2024 to December 2025). ARF was defined as greater than or equal to 24 hours of mechanical ventilation, high-flow nasal cannula, or noninvasive positive pressure ventilation. Fifty-six survivors were enrolled; 20 participated in interviews. Twenty-four survivors (43%) were male, 28 survivors (50%) were identified as Black or African American, 25 survivors (45%) were White, and three survivors (5%) were Hispanic. ARF was most commonly due to respiratory (50%), cardiovascular (23%), or gastrointestinal (7%) disease. Forty-three participants (77%) were mechanically ventilated. ANALYSIS: Qualitative interviews were analyzed using grounded theory. Quantitative measures included the “Heard and Understood” (H&U) measure, the Hospital Anxiety and Depression Scale, the Impact of Events-6 Scale, a 0–100 visual analog scale measuring perceived health, and the EuroQol-5 dimension quality of life measure. Associations between H&U measure responses and mental health outcomes were tested using the Wilcoxon rank-sum and chi-square tests. RESULTS: Patient-centered communication was characterized by meaningful interpersonal relationships, transparent and responsive communication, effective healthcare dynamics, and timely care. Communication perceived as patient-centered improved psychologic well-being, uncertainty tolerance, and engaged shared decision-making. Twenty-one of 56 (38%) participants felt “completely” H&U. Those who did had lower anxiety (4 [1–6] vs. 7 [5–10]; p < 0.01) and depression (6 [5–10] vs. 10 [7–13]; p = 0.02) scores, greater perceived health (80 [70–90] vs. 60 [43–78]; p < 0.01), and greater health-related quality of life (0.84 [0.62–0.94] vs. 0.55 [0.29–0.72]; p < 0.01). CONCLUSIONS: Patient-centered communication may improve psychologic well-being in ARF survivors while admitted and after discharge.

Rationale: Post–intensive care syndrome is a significant challenge for survivors of critical illness. However, little is understood about fear of falls and the concern for falls. Objective: This study sought to quantify the prevalence of fear of falls within the first year after hospital discharge and identify factors associated with high fear of falls. Methods: Using a mixed-methods approach, fear of falls was assessed using the Falls Efficacy Scale International short-form questionnaire with participants dichotomized into low/moderate (7-12) and high (13-28) fear of falls. Persistence was defined as high fear of falls across at least 2 assessment time points. Data were also collected on physical parameters, frailty, cognition, mood, quality of life, and physical activity levels. Participants were assessed at hospital discharge and at 3, 6, and 12 months postdischarge. Results: A high fear of falls was reported in 66 participants in the first 12 months with 41% reporting persistent high fear. High fear primarily commenced at hospital discharge (79%). Hospital discharge factors associated with reduced odds of experiencing high fear of falls in the first 12 months were higher cognition, strength, physical function, balance, and health-related quality of life. Increased odds of experiencing high fear were shown with older age, comorbidities, ICU delirium, frailty, delayed quadriceps time to peak force, and mental health impairments. The final multivariate model found that intensive care unit (ICU) survivors who had ICU delirium were more likely to have high fear of falls (odds ratio [OR], 4.67 [95% CI, 1.18-18.48]) whereas those with better balance were less likely to have high fear (OR, 0.83 [95% CI, 0.74-0.94]). High fear of falls was not predictive of physical activity or function at 6 months; however, it was a significant predictor of depression. Qualitative data highlighted participant concern for further incapacitation through injury and loss of independence. Perceived causes were reduced strength, balance, and fatigue. Participants described strategies they adopted to reduce their risk of falling, including environmental scanning, gait aid use, and slow, deliberate movement. Conclusions: Fear of falls is a significant and persistent challenge for ICU survivors. Modifiable discharge factors exist such as strength, physical function/balance, ICU-related delirium, and mood, which could be the target of future posthospital interventions. Clinical Trials Registration: NCT03141762

OBJECTIVES: To investigate the effect of canine-assisted intervention (CAI) on anxiety symptoms among intensive care patients and their family members. DESIGN: Prospective, single-center, single-arm, nonrandomized, within-subject study design. SETTING: Tertiary hospital ICU. PATIENTS/SUBJECTS: Adult (≥ 16 yr) ICU patients and their family members. INTERVENTIONS: Individual CAI (therapy dog) sessions, lasting at least 15 minutes. MEASUREMENTS AND MAIN RESULTS: Primary outcome: change in Visual Analog Scale for Anxiety (VAS-A) among patients and family members; secondary outcomes (patient cohort): change in: 1) Numeric Pain Rating Scale, 2) physiologic vital signs, and 3) intervention-related adverse events. A total of 141 participants (70 patients and 71 family members) were recruited. The median (interquartile range [IQR]) age (yr) was 63 (49–71) for patients, and 51 (36–61) for family members. There was a significant reduction in anxiety scores after the intervention, with median (IQR) VAS-A scores changing from 5 (1–7) to 0 (0–4 [p < 0.001]) for the patient cohort and from 6 (5–8) to 3 (1–5 [p < 0.001]) for the family cohort. Majority of patients (56/70 [62%]) and family members (63/68 [93%]) demonstrated a greater than or equal to 2-point reduction in VAS-A scores. In terms of pain, median (IQR) scores among the patient cohort were also lower post-intervention (0 [0–5] vs. 0 [0–2]; p < 0.001). There were no statistically significant changes in physiologic vital signs (heart rate, respiratory rate, and systolic blood pressure) among patients following the intervention. Additionally, there were no reported dog bites, scratches, or other adverse events during CAI. CONCLUSIONS: CAI offers immediate therapeutic benefits in reducing anxiety symptoms in ICU patients and their family members with no observed adverse effects. It may also have a potential role as an adjunctive therapy for pain management in ICU patients. Further research should explore the influence on longer-term psychologic outcomes for ICU patients and family members.

U.S. health organizations, including Division 22 of the American Psychological Association, the Society for Critical Care Medicine, and the American Thoracic Society advocate for psychological treatment that improves long-term outcomes in critical illness survivors. However, limited information exists with regard to psychology training opportunities in intensive care settings. We aim to identify and describe (a) existing psychology programs with training in intensive care settings and (b) barriers to finding these training opportunities. Using aspects of the Arksey and O'Malley Framework and Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews reporting checklist as guides, two independent reviewers searched the Association of Psychology Postdoctoral and Internship Centers (APPIC) Directory and Universal Psychology Postdoctoral Directory (UPPD) to identify programs with training experiences in intensive care settings. Searching the APPIC Directory did not reliably or accurately identify training opportunities in intensive care settings. Thus, only programs identified in the more reliable UPPD search were considered for inclusion. After duplicates were removed, searches using the UPPD yielded 31 programs for review. Of those, 22 programs met inclusion, offering heterogeneous training in intensive care settings. These results suggest few opportunities exist for psychology training in intensive care settings and available opportunities are difficult to identify using standard search methods. The identified challenges also emphasize the need for advanced search features for training opportunities within APPIC/UPPD and/or a list of programs offering these training opportunities. Our results highlight the importance of program descriptions that accurately and comprehensively reflect training opportunities-particularly relating to opportunities in intensive care settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

To identify medical phrases utilized by the critical care team that may have an unintended impact on the critically ill patient, we administered an anonymous survey to multi-professional critical care team members. We elicited examples of imprecise language that may have a negative emotional impact on the critically ill. Of the 1600 providers surveyed, 265 offered 1379 examples (912 unique) which were clustered into 5 categories. Medical jargon (eg, “riding the vent”) was most prevalent (n = 549). There were 217 negative suggestions (eg, “you will feel a stick and a burn”). Hyperboles (eg, “black cloud”) were common (n = 198) while homonyms (ie “he fibbed”) accounted for 150 examples. Phrases such as “code brown in there” were categorized as metonyms (n = 144). 121 metaphors/similes (eg, “rearranging deck chairs on the Titanic”) were provided. Phrases that have the potential to negatively impact critically ill patient perceptions are commonplace in critical care practice. Whether these everyday communication habits lead to an unintended nocebo effect on mental health outcomes of the critically ill deserves further study.

Individuals with historically oppressed identities, such as disabled or racialized minorities, face inequities across all societal institutions, including education, criminal justice, and healthcare. Systems of oppression (e.g., ableism, racism) lead to inequities that have ultimately contributed to disproportionate rates of COVID-19 morbidity and mortality in the United States. In the midst of the COVID-19 pandemic, increased public attention regarding police brutality toward Black people and the reinvigoration of the national Black Lives Matter (BLM) movement further highlighted the detrimental effects of oppressive systems and the urgent need to promote equity in the United States. The disproportionate number of COVID-19-related deaths and police brutality are inextricably connected, as both are products of oppression toward minoritized communities. The co-occurrence of the pandemic and BLM movement protests also creates an opportunity for critical discourse on the intersection of ableism and anti-Black racism specifically within the field of rehabilitation psychology. The overarching goals of this review are to apply the Intersectional Ecological Model with the addition of the chronosystem to illustrate how systems of oppression lead to health disparity in COVID-19 survivorship and to provide recommendations to promote health equity. Conclusions/Implication: As the COVID-19 pandemic shifts to an endemic and efforts to eliminate oppressive systems continue, rehabilitation psychologists have an ongoing, evolving, and shared responsibility to employ socially-responsive solutions to promote optimal functioning for patients, families, and communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mechanically ventilated patients experience many adverse symptoms, such as anxiety, thirst, and dyspnea. However, these common symptoms are not included in practice guideline recommendations for routine assessment of mechanically ventilated patients. An American Thoracic Society-sponsored workshop with researchers and clinicians with expertise in critical care and symptom management was convened for a discussion of symptom assessment in mechanically ventilated patients. Members included nurses, physicians, a respiratory therapist, a speech–language pathologist, a critical care pharmacist, and a former intensive care unit patient. This report summarizes existing evidence and consensus among workshop participants regarding 1) symptoms that should be considered for routine assessment of adult patients receiving mechanical ventilation; 2) key symptom assessment principles; 3) strategies that support symptom assessment in nonvocal patients; and 4) areas for future clinical practice development and research. Systematic patient-centered assessment of multiple symptoms has great potential to minimize patient distress and improve the patient experience. A culture shift is necessary to promote ongoing holistic symptom assessment with valid and reliable instruments. This report represents our workgroup consensus on symptom assessment for mechanically ventilated patients. Future work should address how holistic, patient-centered symptom assessment can be embedded into clinical practice.