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. 2014 Dec 9;2014(12):CD010468.
doi: 10.1002/14651858.CD010468.pub2.

Diaries for recovery from critical illness

Amanda J Ullman  1 , Leanne M Aitken, Janice Rattray, Justin Kenardy, Robyne Le Brocque, Stephen MacGillivray, Alastair M Hull
Affiliations

Diaries for recovery from critical illness

Amanda J Ullman et al. Cochrane Database Syst Rev. .

Abstract

Background: During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient's recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staff to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient's ICU admission and an ongoing narrative outlining day-to-day activities.

Objectives: To assess the effect of a diary versus no diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), Ovid MEDLINE (1950 to January 2014), EBSCOhost CINAHL (1982 to January 2014), Ovid EMBASE (1980 to January 2014), PsycINFO (1950 to January 2014), Published International Literature on Traumatic Stress (PILOTS) database (1971 to January 2014); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to January 2014); seven clinical trial registries and reference lists of identified trials. We applied no language restriction.

Selection criteria: We included randomized controlled trials (RCTs) or clinical controlled trials (CCTs) that evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs.

Data collection and analysis: We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to prespecified criteria.

Main results: We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). The study involving relatives of ICU patients was a substudy of family members from one of the ICU patient studies. There was a mixed risk of bias within the included studies. Blinding of participants to allocation was not possible and blinding of the outcome assessment was not adequately achieved or reported. Overall the quality of the evidence was low to very low. The patient diary intervention was not identical between studies. However, each provided a prospectively prepared, day-to-day description of the participants' ICU admission.No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. However, the results were imprecise and consistent with benefit in either group, or no difference. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38).

Authors' conclusions: Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

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Conflict of interest statement

Amanda J Ullman: none known

Leanne M Aitken: none known

Janice Rattray: none known

Justin Kenardy: none known

Robyne Le Brocque: none known

Stephen MacGillivray: none known

Alastair M Hull: none known

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010468

References

References to studies included in this review

Jones 2010 {published and unpublished data}
    1. Jones C, Backman C, Capuzzo M, Egerod I, Flaatten H, Granja C, et al and the RACHEL group. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Critical Care 2010;14(5):R168. [PUBMED: 20843344] - PMC - PubMed
Jones 2012 {published and unpublished data}
    1. Jones C, Backman C, Griffiths RD. Intensive care diaries and relatives' symptoms of posttraumatic stress disorder after critical illness: a pilot study. American Journal of Critical Care 2012;21(3):172‐6. [PUBMED: 22549573] - PubMed
Knowles 2009 {published and unpublished data}
    1. Knowles R, Tarrier N. Evaluation of the effect of prospective patient diaries on emotional well‐being in intensive care unit survivors: A randomized controlled trial. Critical Care Medicine 2009;37(1):184‐91. [PUBMED: 19050634] - PubMed

References to studies excluded from this review

AACN 2012 {published data only}
    1. Unknown. ICU diaries may reduce PTSD effect for families, patients. AACN Bold Voices 2012;4(10):15. [ISSN: 1948‐7088]
Backman 2001 {published data only}
    1. Backman C, Walther S. Use of a personal diary written on the ICU during critical illness. Intensive Care Medicine 2001;27(2):426‐9. [PUBMED: 11396288] - PubMed
Backman 2010 {published data only}
    1. Backman C, Orwelius L, Sjoberg F, Fredrikson M, Walther S. Long‐term effect of the ICU‐diary concept on quality of life after critical illness. Acta Anaesthesiologica Scandinavica 2010;54(6):736‐43. [PUBMED: 20236095] - PubMed
Bagger 2006 {published data only}
    1. Bagger C. Diary for critically ill patients. Svgelplejersken 2006;25‐26:62‐5. [ISSN: 0106‐8350]
Garrouste‐Orgeas 2012 {published data only}
    1. Garrouste‐Orgeas M, Coquet I, Périer A, Timsit JF, Pochard F, Lancrin F, et al. Impact of an intensive care unit diary on psychological distress in patients and relatives. Critical Care Medicine 2012;40(7):2033‐40. [PUBMED: 22584757] - PubMed
Hale 2010 {published data only}
    1. Hale M, Parfitt L, Rich T. How diaries can improve the experience of intensive care patients. Nursing Management ‐ UK 2010;17(8):14‐8. [PUBMED: 21229866] - PubMed
Hayes 2008 {published data only}
    1. Hayes A, Kelly A. Patient diaries: can they offer psychological help to cancer patients?. Cancer Nursing Practice 2008;7(6):25‐9. [ISSN: 1475‐4266]
MacDonald 2011 {published data only}
    1. MacDonald G, Livy K, Shustack A. Did that really happen? Delusional memories and the impact of an ICU patient diary. Canadian Association of Critical Care Nurses. 2011; Vol. 22:2.
Robson 2008 {published data only}
    1. Robson W. An evaluation of patient diaries in intensive care. Connect: The World of Critical Care Nursing 2008;6(2):34‐7.

Additional references

Adamson 2004
    1. Adamson H, Murgo M, Boyle M, Kerr S, Crawford M, Elliot D. Memories of intensive care experiences of survivors of a critical illness: an interview study. Intensive and Critical Care Nursing 2004;20(5):257. [PUBMED: 15450614] - PubMed
Adhikari 2011
    1. Adhikari NKJ, Rubenfeld GD. Worldwide demand for critical care. Current Opinion in Critical Care 2011;17(6):620‐5. [PUBMED: 22067878] - PubMed
Aitken 2014
    1. Aitken LM, Chaboyer W, Schuetz M, Joyce C, Macfarlane B. Health status of critically ill trauma patients. Journal of Clinical Nursing 2014;23(5‐6):704‐15. [PUBMED: 23228039] - PubMed
Akerman 2010
    1. Akerman E, Granber‐Axell A, Ersson A, Fridlund B, Bergbon I. Use and practice of patient diaries in Swedish intensive care units: a national survey. Nursing in Critical Care 2010;15(1):26‐33. [PUBMED: 20070812] - PubMed
American Psychiatric Association 2013
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th Edition. Washington DC: American Psychiatric Association, 2013.
Bergbom 1999
    1. Bergbon I, Svennson C, Berggren E, Kamsula M. Patients' and relatives' opinions and feelings about diaries kept by nurses in an intensive care unit: pilot study. Intensive and Critical Care Nurse 1999;15(4):185‐91. [PUBMED: 10786503] - PubMed
Blackwood 2014
    1. Blackwood B, Clarke M, McAuley DF, McGuigan PJ, Marshall JC, Rose L. How outcomes are defined in clinical trials of mechanically ventilated adults and children. American Journal of Respiratory and Critical Care Medicine 2014;189(8):886‐93. [PUBMED: 24512505] - PubMed
Bledsoe 2002
    1. Bledsoe BE. Critical incident stress management (CISM): benefit or risk for emergency services. Prehospital Emergency Care 2002;7(2):272‐9. [PUBMED: 12710792] - PubMed
Combe 2005
    1. Coombe D. The use of patient diaries in an intensive care unit. Nursing in Critical Care 2005;10(1):31‐4. [PUBMED: 15739637] - PubMed
Craig 2007
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655. [PUBMED: 18824488] - PMC - PubMed
Cuthbertson 2007
    1. Cuthbertson B, Rattray J, Johnston M, Wildsmith J, Wilson E, Hernendez R, et al. A pragmatic randomised, controlled trial of intensive care follow up programmes in improving longer‐term outcomes from critical illness: the PRACTICAL study. BMC Health Services Research 2007;7:116. [PUBMED: 17645791] - PMC - PubMed
Davydow 2009
    1. Davydow DS, Gifford JM, Desai SV, Bienvenu OJ, Needham DM. Depression in general intensive care unit survivors: a systematic review. Intensive Care Medicine 2009;35(5):796‐809. [PUBMED: 19165464] - PMC - PubMed
Egerod 2007
    1. Egerod I, Schwartz‐Nielsen K, Hansen G, Laerkner E. The extent and application of patient diaries in Danish ICUs in 2006. Nursing in Critical Care 2007;12(3):159‐67. [PUBMED: 17883648] - PubMed
Egerod 2009
    1. Egerod I, Christensen D. Analysis of patient diaries in Danish ICUs: a narrative approach. Intensive and Critical Care Nursing 2009;25(5):268‐77. [PUBMED: 19632844] - PubMed
Egerod 2010
    1. Egerod I, Bagger C. Patients' experiences of intensive care diaries ‐ a focus group study. Intensive and Critical Care Nursing 2010;26(5):278‐87. [PUBMED: 20692158] - PubMed
Egerod 2011a
    1. Egerod I, Christensen D, Schwartz‐Nielsen K, Agard AS. Constructing the illness narrative: a grounded theory exploring patients' and relatives' use of intensive care diaries. Critical Care Medicine 2011;39(8):1922‐8. [PUBMED: 21572330] - PubMed
Egerod 2011b
    1. Egerod I, Storli SL, Akerman E. Intensive care diaries in Scandinavia: a comparative study of emergence and evolution. Nursing Inquiry 2011;18(3):235‐46. [PUBMED: 21790874] - PubMed
Egger 1997
    1. Egger M, Smith GD, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. [PUBMED: 9310563] - PMC - PubMed
Engstrom 2009
    1. Engstrom A, Grip K, Hamren M. Experiences of intensive care unit diaries: 'touching a tender wound'. Nursing in Critical Care 2009;14(2):61‐7. [PUBMED: 19243522] - PubMed
Gjengedal 2010
    1. Gjengedal E, Storli SL, Holme AN, Eskerud RS. An act of caring ‐ patient diaries in Norwegian intensive care units. Nursing in Critical Care 2010;15(4):176‐84. [PUBMED: 20626794] - PubMed
Granja 2008
    1. Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, et al. Understanding posttraumatic stress disorder‐related symptoms after critical care: the early amnesia hypothesis. Critical Care Medicine 2008;36(10):2801. [PUBMED: 18766108] - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck‐Ytter Y, Schünemann HJ, GRADE working group. What is "quality of evidence" and why is it important to clinicians?. BMJ 2008;336(7651):995‐8. [PUBMED: 18456631] - PMC - PubMed
Higgins 2011
    1. Higgins J, Altman D. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. 5.1.0. Chichester (UK): John Wiley & Sons, 2011.
Jackson 2007
    1. Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, Wesley E. Post‐traumatic stress disorder and post‐traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Critical Care 2007;11(1):R27. [PUBMED: 17316451] - PMC - PubMed
Jones 2000
    1. Jones C, Humphris G, Griffiths R. Preliminary validation of the ICUM tool: a tool for assessing memory of the intensive care experience. Clinical Intensive Care 2000;11(5):251‐5.
Jones 2001
    1. Jones C, Griffiths R, Humphris G, Skirrow P. Memory, delusions and the development of acute post‐traumatic stress disorder‐related symptoms after intensive care. Critical Care Medicine 2001;29(3):573‐80. [PUBMED: 11373423] - PubMed
Kiekkas 2010
    1. Kiekkas P, Theodorakopoulou G, Spyratos F, Baltopoulos GI. Psychological distress and delusional memories after critical care: a literature review. International Nursing Review 2010;57(3):288‐96. [PUBMED: 20796057] - PubMed
Layne 2007
    1. Layne CM, Warren JS, Watson PJ, Shalev AY. Risk, vulnerabilities, resistance and resilience: towards integrated conceptualization of posttraumatic adaptation. In: Friedman MJ, Keane TM, Watson PA editor(s). Handbook of PTSD, Science and Practice. New York: Guilford Press, 2007:497‐520.
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville F. Chapter 6: Searching for studies. In: Higgins J, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. 5.1.0. Chichester (UK): John Wiley & Sons, 2011.
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine 2009;6(7):e1000100. [PUBMED: 19621070] - PMC - PubMed
Meriläginen 2010
    1. Meriläinen M, Kyngäs H, Ala‐Kokko T. 24‐hour intensive care: an observational study of an environment and events. Intensive and Critical Care Nursing 2010;26(5):246‐53. [PUBMED: 20656491] - PubMed
Myhren 2009
    1. Myhren J, Toien L, Ekeberg A, Karlsson S, Sandvik L, Stokland O. Patient memory and psychological distress after ICU stay compared with expectations of the relatives. Intensive Care Medicine 2009;35(12):2078. [PUBMED: 19756511] - PubMed
Nydahl 2010
    1. Nydahl P, Knuck D, Egerod I. The extent and application of patient diaries in German intensive care units. CONNECT: The World of Critical Care Nursing 2010;7(2):122‐6.
Rattray 2005
    1. Rattray J, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia 2005;60(11):1085‐92. [PUBMED: 16229693] - PubMed
Rattray 2010
    1. Rattray J, Crocker C, Jones M, Connaghan J. Patients' perception of and emotional outcome after intensive care: results from a multicentre survey. Nursing in Critical Care 2010;15(2):86‐93. [PUBMED: 20236435] - PubMed
RevMan 5.2 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Ringdal 2009
    1. Ringdal M, Plos K, Lundberg D, Johansson L, Bergbom I. Outcome after injury: memories, health‐related quality of life, anxiety and symptoms of depression after intensive care. The Journal of Trauma: Injury, Infection and Critical Care 2009;66(4):1226. [PUBMED: 19088550] - PubMed
Rose 2002
    1. Rose SC, Bisson J, Churchill R, Wessley S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD000560] - DOI - PubMed
Roulin 2007
    1. Roulin M, Hurst S, Spirig R. Diaries written for ICU patients. Qualitative Health Research 2007;17(7):893‐901. [PUBMED: 17724101] - PubMed
Samuelson 2007
    1. Samuelson KAM, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients: a 2‐month follow‐up study. Acta Anaesthesiologica Scandinavica 2007;51(6):671‐8. [PUBMED: 17567267] - PubMed
Schelling 2003
    1. Schelling G, Richter M, Roozendaal B, Rothenhausler HB, Krauseneck T, Stoll C, et al. Exposure to high stress in the intensive care unit may have negative effects on health‐related quality‐of‐life outcomes after cardiac surgery. Critical Care Medicine 2003;31(7):1971‐80. [PUBMED: 12847391] - PubMed
Schulz 2010
    1. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332. [PUBMED: 20332509] - PMC - PubMed
Snaith 2003
    1. Snaith RP. The hospital anxiety and depression scale. Health and Quality of Life Outcomes 2003;1(1):29. [PUBMED: 12914662] - PMC - PubMed
Storli 2009
    1. Storli S, Lind R. The meaning of follow‐up in intensive care: patients' perspective. Scandanavian Journal of Caring Sciences 2009;23(1):45‐56. [PUBMED: 19250451] - PubMed
Sukantarat 2007
    1. Sukantarat K, Greer S, Brett S, Williamson R. Physical and psychological sequelae of critical illness. British Journal of Health Psychology 2007;12(Pt 1):65‐74. [PUBMED: 17288666] - PubMed
Twigg 2008
    1. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. Use of a screening questionnaire for post‐traumatic stress disorder (PTSD) on a sample of UK ICU patients. Acta Anaesthesiologica Scandinavica 2008;52(2):202‐8. [PUBMED: 18005373] - PubMed
Zigmond 1983
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983;67(6):361‐70. [PUBMED: 6880820] - PubMed

References to other published versions of this review

Ullman 2013
    1. Ullman AJ, Aitken LM, Rattray J, Kenardy J, Brocque R, MacGillivray S, et al. Diaries for recovery from critical illness. Cochrane Database of Systematic Reviews 2013, Issue 4. [DOI: 10.1002/14651858.CD010468] - DOI - PMC - PubMed

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