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Acute Respiratory Failure Survivors' Perspectives on Patient-Centered Communication: A Mixed Methods Study
Diana C Bouhassira1, Suratsawadee Kruahong2, Martha Abshire Saylor3
1Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
Importance:
Many acute respiratory failure (ARF) survivors develop psychiatric sequelae. Inpatient psychologic distress is an important risk factor.
Objectives:
Evaluate ARF survivors' perspectives on patient-centered communication and its relationship to the inpatient psychologic experience.
Design, Setting, And Participants:
A mixed methods prospective observational study involving one survey and a semi-structured interview administered within 6 weeks of discharge to ARF survivors from two hospitals in the same system (August 2024 to December 2025). ARF was defined as greater than or equal to 24 hours of mechanical ventilation, high-flow nasal cannula, or noninvasive positive pressure ventilation. Fifty-six survivors were enrolled; 20 participated in interviews. Twenty-four survivors (43%) were male, 28 survivors (50%) were identified as Black or African American, 25 survivors (45%) were White, and three survivors (5%) were Hispanic. ARF was most commonly due to respiratory (50%), cardiovascular (23%), or gastrointestinal (7%) disease. Forty-three participants (77%) were mechanically ventilated.
Analysis:
Qualitative interviews were analyzed using grounded theory. Quantitative measures included the "Heard and Understood" (H&U) measure, the Hospital Anxiety and Depression Scale, the Impact of Events-6 Scale, a 0-100 visual analog scale measuring perceived health, and the EuroQol-5 dimension quality of life measure. Associations between H&U measure responses and mental health outcomes were tested using the Wilcoxon rank-sum and chi-square tests.
Results:
Patient-centered communication was characterized by meaningful interpersonal relationships, transparent and responsive communication, effective healthcare dynamics, and timely care. Communication perceived as patient-centered improved psychologic well-being, uncertainty tolerance, and engaged shared decision-making. Twenty-one of 56 (38%) participants felt "completely" H&U. Those who did had lower anxiety (4 [1-6] vs. 7 [5-10]; p < 0.01) and depression (6 [5-10] vs. 10 [7-13]; p = 0.02) scores, greater perceived health (80 [70-90] vs. 60 [43-78]; p < 0.01), and greater health-related quality of life (0.84 [0.62-0.94] vs. 0.55 [0.29-0.72]; p < 0.01).
Conclusions:
Patient-centered communication may improve psychologic well-being in ARF survivors while admitted and after discharge.
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