None listed
Conditions
Brief summary
International and local research indicates that Intensive Care Unit (ICU) survivors (patients and families) experience adverse outcomes. In Australia, ICU survivors return home with little or no follow-up. Peer support, which brings survivors together to share experiences, holds potential to improve post-ICU outcomes although this warrants exploration. We have recently developed an in-person peer support model, where we engaged both ICU survivors and staff using a new and innovative method called experience-based co-design (EBCD). We recently tested the feasibility of this co-designed in-person peer support model for ICU survivors via a pilot trial (PMID: 38360469), that also included an ICU recovery booklet. Despite multiple strategies (including paying for car-parking, and travel costs), there were barriers to participants attending the hospital in-person. Further, the global pandemic necessitated the need to find ways of supporting ICU survivors in their recovery and in a format that did not require in-person attendance at hospital for this program. A further feasibility pilot trial was completed to test a digital format of this co-designed intervention, as well as a digital version of the ICU recovery booklet. This trial found that a digital peer support program and booklet, was feasible to deliver with regards to attendance rates, recruitment, and participant satisfaction. This next study will test these interventions at scale to determine the effectiveness of these interventions across the following two groups: 1. Digital peer support and an ICU recovery booklet; 2. Control care (no formal specialised ICU follow-up or ICU specific recovery information). We hypothesise that the digital peer support program and the recovery booklet will improve the health of participants at 90 days after hospitalisation, with reduced psychological distress, and improved social and informational support and resilience compared to usual care.
Interventions
Intervention group (peer support + recovery booklet):
Additional to standard care (Intervention) summarized here:
What? Digital, facilitated peer support group. Two components:
1) Educational/informational exchange delivered by staff on common problems faced after ICU
2) Group/peer to peer discussion of shared experiences and pragmatic solutions
The formal component is education delivered by expert clinicians, at the participant pace with time for questions from participants. This education is
Intervention group (peer support + recovery booklet): Additional to standard care (Intervention) summarized here: What? Digital, facilitated peer support group. Two components: 1) Educational/informational exchange delivered by staff on common problems faced after ICU 2) Group/peer to peer discussion of shared experiences and pragmatic solutions The formal component is education delivered by expert clinicians, at the participant pace with time for questions from participants. This education is delivered via powerpoint using the Zoom screen-share function. The informal component includes facilitated peer-to-peer discussion to share experiences and support social cohesion, led by a social worker or psychologist skilled in-group facilitation. When? 1x fortnight, starting at 6-8 weeks post-hospital discharge Where? Online, via Zoom platform For how long? 1-hour session total (30 minutes formal introduction + 30 minutes facilitated peer support), for a total of 4 topics, fortnightly across 8 weeks. The digital peer support program will be an ongoing ‘rolling’ program, with sessions held every 2 weeks - so participants will enter program at one topic, and keep attending until all four topics completed, then exit program. Participants will also be provided with an education booklet, which was co-designed and has undergone extensive consumer engagement. The consumer engagement process included stakeholder input from ICU patients, ICU caregivers, ICU clinicians and researchers to develop the comprehensive booklet to support the recovery process. The content was developed by expert clinician presenters and the project team, and then sent to patient and caregivers for feedback using an iterative process, over a fortnight. The initial experienced based co-design methodology used to develop the peer support program occurred using stakeholder consumer input over three 2 hour workshops over a one month period, the information generated through this process was incorporated into this document. The feedback sought during the pilot trial from participants was also included in the development process for this booklet. The booklet contains patient and carer focused information that explains some of the potential impacts of critical illness on their health (e.g. post-intensive care syndrome), and where to seek support following hospital discharge, has a section on goal-setting and useful information that can be shared with their general practitioner. Intervention adherence for this group will be monitored with an attendance log, completed by peer support facilitators each session.
Sponsors
Department of Critical Care, The University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• ICU admission >48 hours at participating hospital • Age 18 years and over • Access to digital platform (functioning computer, internet access and speed, capacity to log onto a video-sharing platform)
Exclusion criteria
• Death anticipated as likely prior to day 90/180 outcome assessment • Deemed high risk of loss to follow up by research staff. • Diagnosed pre-existing or new cognitive conditions that would prevent ability to participate in the intervention or outcome assessment. • Referred or transferred to the Psychiatric Services during the hospitalisation period as identified in medical file • Severe neurological conditions (e.g. severe traumatic brain injury) that would prevent ability to participate in the intervention or outcome assessment. • Not expected to return home following discharge • Lack of either a reliable smartphone with a data plan or internet or a computer with internet, webcam and microphone access; or phone access • Unable to effectively communicate in English, and that would prevent ability to participate in the intervention or outcome assessment • Any other reason preventing participants from participating in intervention, including but not limited to: known criminal activity, known personality disorder.
Outcome results
None listed