Hope among patients discharged from an intensive care unit: A prospective cohort study

Abstract

BACKGROUND: Hope is important during critical illness due to the uncertainty and loss of control in the patient's life. Following intensive care, hope might provide a therapeutic effect and increase coping, leading to improved recovery. AIM: To describe the levels of hope in patients during the first year after ICU treatment, and to explore possible associations between hope and selected demographic, clinical and psychosocial factors. STUDY DESIGN: This is a prospective cohort study and a predefined sub-study of a randomized controlled trial. Adults discharged from five mixed ICUs were included. All patients were screened for post-traumatic stress symptoms at baseline, and data on hope, post-traumatic stress and social support were collected 3, 6 and 12 months later. Linear regression analyses and linear mixed models for repeated measurements with hope as the dependent variable were used. RESULTS: Median age was 57 years (range 18-94), 47% were women, median length of ICU stay was 3 days (range 1-83), Simplified Acute Physiology Score II was 24 (range 0-78) and 54% received mechanical ventilation. Not having prior mental health problems (B = 1.93, 95% CI [0.90, 2.98]), lower level of post-traumatic stress symptoms (B = -0.08, 95% CI [-0.11, -0.04]) and more social support (B = 0.37, 95% CI [0.31, 0.43]) were all independently associated with higher levels of hope during the first year after critical illness. The levels of hope were higher in the study cohort than in the general Norwegian population and remained unchanged during follow-up. CONCLUSIONS: Patients maintained a stable level of hope throughout follow-up. Absence of prior mental health problems, lower post-traumatic stress symptoms and more social support after ICU discharge were associated with higher hope. RELEVANCE TO CLINICAL PRACTICE: Patients' hope should be strengthened during the ICU stay through psychosocial support and care for patients with previous post-traumatic stress symptoms and mental health problems.

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