Transitions of Care After Critical Illness—Challenges to Recovery and Adaptive Problem Solving*
Kimberley Haines, Elizabeth Hibbert, Nina Leggett, Leanne M. Boehm, Tarli Hall, Rita N. Bakhru, Anthony J. Bastin, Brad W. Butcher, Tammy L. Eaton, Wendy Harris, Aluko A. Hope, James C. Jackson, Annie Johnson, Janet A. Kloos, Karen Korzick, Pamela MacTavish, Joel Meyer, Ashley Montgomery-Yates, Tara Quasim, Andrew Slack, Dorothy Wade, Mary Still, Giora Netzer, Ramona O. Hopkins, Theodore J. Iwashyna, Mark E. Mikkelsen, Joanne McPeake, Carla M. Sevin
Abstract
OBJECTIVES: Investigate the challenges experienced by survivors of critical illness and their caregivers across the transitions of care from intensive care to community, and the potential problem-solving strategies used to navigate these challenges. DESIGN: Qualitative design-data generation via interviews and data analysis via the framework analysis method. SETTING: Patients and caregivers from three continents, identified through the Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups). SUBJECTS: Patients and caregivers following critical illness. INTERVENTIONS: Nil. MEASUREMENTS AND MAIN RESULTS: From 86 interviews (66 patients, 20 caregivers), we identified the following major themes: 1) Challenges for patients-interacting with the health system and gaps in care; managing others' expectations of illness and recovery. 2) Challenges for caregivers-health system shortfalls and inadequate communication; lack of support for caregivers. 3) Patient and caregiver-driven problem solving across the transitions of care-personal attributes, resources, and initiative; receiving support and helping others; and acceptance. CONCLUSIONS: Survivors and caregivers experienced a range of challenges across the transitions of care. There were distinct and contrasting themes related to the caregiver experience. Survivors and caregivers used comparable problem-solving strategies to navigate the challenges encountered across the transitions of care.