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Surviving a Critical Care Admission for COVID-19: A Qualitative Study of Experiences and Unmet Needs During the
Mary Gemma Cherry1, Stephen L Brown2, Alicia A C Waite3,4
1Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
Background:
Admission to an intensive care unit (ICU) places substantial physical, psychological and existential burden on patients, but little is known about the support needs of survivors of COVID-19 critical care.
Aim:
To explore the experiences of survivors of COVID-19 critical illness during their recovery phase, including perceptions of care received and support offered to them. Research questions were (i) what are patients' experiences during ICU admission and in the recovery period at a psychological, physical and functional level and (ii) what are participants' preferences for support during the post-discharge period?
Study Design:
A qualitative study nested within a national multicentre longitudinal study examining the psychological impact of COVID-19 critical care. Semi-structured interviews were conducted with adult patients aged ≥ 18 years, treated for presumed/diagnosed COVID-19 infection and survived to ICU discharge following an admission of ≥ 24 h. Interviews explored patients' ICU and post-discharge experiences and preferences for post-discharge support. Analysis drew on principles of the constant comparative method and interpretive reflexive thematic analysis.
Findings:
Fifteen participants completed interviews. Participants reported uncertainties and difficulties in adjusting to their illness, to ICU care and to post-ICU discharge. Participants experienced extreme functional loss and knew their illnesses to be highly dangerous, yet did not appraise their symptoms as being severe. This dissonance was exacerbated by the dearth of knowledge regarding the effects and prognosis of COVID-19 critical illness. Participants desired follow-up support but more commonly spoke of wanting to negotiate a clear path towards recovery and being disappointed in some professionals' failures to provide this. Psychological symptoms emerged later in survivorship, but patients did not routinely access psychological support.
Conclusions:
More tailored and consistent post-discharge support, using novel approaches, may standardise equity of care and address patients' needs.
Relevance To Clinical Practice:
Greater support for patients and staff is needed to facilitate understanding and acceptance of uncertainty related to unprecedented public health emergencies such as COVID-19.
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