King J1, O'Neill B2, Ramsay P3, Linden M4, Darweish Medniuk A5, Outtrim J6, Blackwood B7
1University of Ottawa, Physiotherapy Program, School of Rehabilitation Sciences, Ottawa, Canada, 2Ulster University, Centre for Health Rehabilitation Technologies, INHR, Newtownabbey, United Kingdom, 3Napier University, School of Health and Social Care, Edinburgh, United Kingdom, 4Queen's University Belfast, School of Nursing and Midwifery, Belfast, United Kingdom, 5Southmeade Hospital, North Bristol NHS Trust, Department of Anaesthesia, Bristol, United Kingdom, 6University of Cambridge, Division of Anaesthesia, Department of Medicine, Cambridge, United Kingdom, 7Queen's University Belfast, Centre of Experimental Medicine (CEM), School of Medicine, Dentistry and Biomedical Sciences, Belfast, United Kingdom

Background: Throughout the world physiotherapists and other health care professionals work with people who have required an admission to an intensive care unit. Often times these intensive care survivors suffer chronic and potentially life-changing physical, psychosocial and cognitive sequelae, and supporting their recovery is an international priority. As survivors transition from the intensive care unit to home, their support needs develop and change. An understanding of needs at different transition periods would help inform health services including support for survivors.

Purpose: To identify patients' support needs (informational, emotional, instrumental, appraisal, and spiritual) following an ICU admission. We aimed to map these against the Timing it Right framework (Cameron, 2008), a framework that reflects a patient's transition from intensive care (event/diagnosis); to ward (stabilisation/preparation); and discharge home (implementation/adaptation).

Methods: We conducted a scoping review of published qualitative research studies using the Arksey and O'Malley (2005) and Levac (2010) frameworks. We searched major databases from 2000 to 2017. We included qualitative research studies that reported adult critical care survivors' experiences of care and identified support needs with reference to the Timing it Right framework. Two reviewers independently screened, extracted and coded data. Data were analysed using a thematic framework approach. The review team reviewed and affirmed findings.

Results: From 3035 references we included 32 studies. These qualitative studies used a variety of approaches including descriptive/narrative (n= 16); grounded theory (n=4); interpretive (n=1); mixed methods (n=3); phenomenology (n=7); or survey (n=4) approach. Studies were conducted in the United Kingdom (n=12); Australia (n=5); United States (n=4); Canada (n=2); Sweden (n=3); with one study each conducted in Denmark, France, Jordan, Hong Kong and New Zealand; and one international study including participants from Australia, Canada, New Zealand United Kingdom and the United States.
Patient needs were collected at various time-points from ICU admission to over 5 years post-hospital discharge. Informational, emotional, instrumental, social and spiritual support needs differed when mapped against the time points of the Timing it Right framework. For example, in the stabilisation/preparation phases (hospital) support was needed with physical and cognitive disabilities, and for training to relearn personal care tasks; in the implementation/adaptation phase (home/community,) support was needed for higher level cognitive function, and achieving pre-ICU level of strength, and return to work. Appraisal needs, including patients receiving feedback from health care professionals on their overall progress, were not apparent in the event/diagnosis stage and spiritual needs were apparent in the stabilisation and implementation/adaption stages.

Conclusion(s): Our review is the first to identify the change in support needs among intensive care survivors as they transition from intensive care to the home environment. The mapping of support needs across time may inform service provision.

Implications: This scoping review provides valuable insights into the different support needs of intensive care survivors. Physiotherapists and other health care professionals need to take these support needs into account when planning programs and interventions for intensive care survivors.

Keywords: ICU, patient needs, critical illness

Funding acknowledgements: Intensive Care Society

Topic: Cardiorespiratory; Research methodology & knowledge translation; Cardiorespiratory

Ethics approval required: No
Institution: University of Ottawa
Ethics committee: The Health Sciences and Science Research Ethics Board
Reason not required: Ethical approval is not required in Canada to conduct research that does not involve humans/animals.

All authors, affiliations and abstracts have been published as submitted.

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