Article Text
Abstract
Objectives Adverse psychological outcomes, following stressful experiences in critical care, affect up to 50% of patients. We aimed to develop and test the feasibility of a psychological intervention to reduce acute stress and prevent future morbidity.
Design A mixed-methods intervention development study, using two stages of the UK Medical Research Council framework for developing and testing complex interventions. Stage one (development) involved identifying an evidence base for the intervention, developing a theoretical understanding of likely processes of change and modelling change processes and outcomes. Stage two comprised two linked feasibility studies.
Setting Four UK general adult critical care units.
Participants Stage one: former and current patients, and psychology, nursing and education experts. Stage two: current patients and staff.
Outcomes Feasibility and acceptability to staff and patients of content and delivery of a psychological intervention, assessed using quantitative and qualitative data. Estimated recruitment and retention rates for a clinical trial.
Results Building on prior work, we standardised the preventative, nurse-led Provision Of Psychological support to People in Intensive Care (POPPI) intervention. We devised courses and materials to train staff to create a therapeutic environment, to identify patients with acute stress and to deliver three stress support sessions and a relaxation and recovery programme to them. 127 awake, orientated patients took part in an intervention feasibility study in two hospitals. Patient and staff data indicated the complex intervention was feasible and acceptable. Feedback was used to refine the intervention. 86 different patients entered a separate trial procedures study in two other hospitals, of which 66 (80% of surviving patients) completed questionnaires on post-traumatic stress, depression and health 5 months after recruitment.
Conclusion The ‘POPPI’ psychological intervention to reduce acute patient stress in critical care and prevent future psychological morbidity was feasible and acceptable. It was refined for evaluation in a cluster randomised clinical trial.
Trial registration number ISRCTN61088114; Results.
- adult psychiatry
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Footnotes
Contributors Early conceptual and development work for the POPPI intervention was carried out by DW, JWei, DH, MM, DS, JWel, NA, MH, CW and CB at University College London Hospitals. Further development of the intervention and design of the feasibility phase of the POPPI study were carried out with KMR, SH, DAH, PRM, ARB, DD and VB. DW drafted the initial manuscript with input from KMR. All authors revised the manuscript critically and gave their approval of the final version. DW is the guarantor.
Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (Project: 12/64/124).
Disclaimer The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the HS&DR, NIHR, NHS or the Department of Health.
Competing interests DW also received funding from the University College London/University College London Hospitals NIHR Biomedical Research Centre.
Patient consent Not required.
Ethics approval The two feasibility studies were granted favourable ethical opinion by the NRES Committee South Central – Oxford B research ethics committee on 23 April 2014 (reference: 14/SC/0149), were managed by the ICNARC CTU and prospectively registered on the ISRCTN Registry (ISRCTN61088114).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.