Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma

David Y Hwang^#¹, Sarah M Bannon^#², Kate Meurer³, Rina Kubota³, Nithyashri Baskaran³, Jisoo Kim³, Qiang Zhang⁴, Mira Reichman⁵, Nathan S Fishbein², Kaitlyn Lichstein², Melissa Motta⁶, Susanne Muehlschlegel⁷, Michael E Reznik⁸, Matthew N Jaffa⁹, Claire J Creutzfeldt¹⁰, Corey R Fehnel¹¹, Amanda D Tomlinson¹², Craig A Williamson¹³, Ana-Maria Vranceanu²; COMA-F Investigators

Affiliations

¹ Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA. david_hwang@med.unc.edu.
² Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
⁴ David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
⁵ Department of Psychology, University of Washington, Seattle, WA, USA.
⁶ Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁷ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁸ Department of Neurology, Alpert Medical School, Brown University, Providence, RI, USA.
⁹ Department of Neurointensive Care, Hartford Hospital, Hartford, CT, USA.
¹⁰ Department of Neurology, University of Washington and Harborview Medical Center, Seattle, WA, USA.
¹¹ Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
¹² Department of Critical Care Medicine, College of Medicine, Mayo Clinic, Jacksonville, FL, USA.
¹³ Department of Neurology, University of Michigan, Ann Arbor, MI, USA.

^# Contributed equally.

PMID: 37523110
PMCID: PMC11426341
DOI: 10.1007/s12028-023-01804-3

Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma

David Y Hwang et al. Neurocrit Care. 2024 Apr.

. 2024 Apr;40(2):674-688.

doi: 10.1007/s12028-023-01804-3. Epub 2023 Jul 31.

Authors

Affiliations

¹ Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA. david_hwang@med.unc.edu.
² Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
⁴ David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.
⁵ Department of Psychology, University of Washington, Seattle, WA, USA.
⁶ Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
⁷ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁸ Department of Neurology, Alpert Medical School, Brown University, Providence, RI, USA.
⁹ Department of Neurointensive Care, Hartford Hospital, Hartford, CT, USA.
¹⁰ Department of Neurology, University of Washington and Harborview Medical Center, Seattle, WA, USA.
¹¹ Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
¹² Department of Critical Care Medicine, College of Medicine, Mayo Clinic, Jacksonville, FL, USA.
¹³ Department of Neurology, University of Michigan, Ann Arbor, MI, USA.

^# Contributed equally.

PMID: 37523110
PMCID: PMC11426341
DOI: 10.1007/s12028-023-01804-3

Abstract

Background: Family caregivers of patients with severe acute brain injury (SABI) admitted to intensive care units (ICUs) with coma experience heightened emotional distress stemming from simultaneous stressors. Stress and coping frameworks can inform psychosocial intervention development by elucidating common challenges and ways of navigating such experiences but have yet to be employed with this population. The present study therefore sought to use a stress and coping framework to characterize the stressors and coping behaviors of family caregivers of patients with SABI hospitalized in ICUs and recovering after coma.

Methods: Our qualitative study recruited a convenience sample from 14 US neuroscience ICUs. Participants were family caregivers of patients who were admitted with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, or hypoxic-ischemic encephalopathy; had experienced a comatose state for > 24 h; and completed or were scheduled for tracheostomy and/or gastrostomy tube placement. Participants were recruited < 7 days after transfer out of the neuroscience ICU. We conducted live online video interviews from May 2021 to January 2022. One semistructured interview per participant was recorded and subsequently transcribed. Recruitment was stopped when thematic saturation was reached. We deductively derived two domains using a stress and coping framework to guide thematic analysis. Within each domain, we inductively derived themes to comprehensively characterize caregivers' experiences.

Results: We interviewed 30 caregivers. We identified 18 themes within the two theory-driven domains, including ten themes describing practical, social, and emotional stressors experienced by caregivers and eight themes describing the psychological and behavioral coping strategies that caregivers attempted to enact. Nearly all caregivers described using avoidance or distraction as an initial coping strategy to manage overwhelming emotions. Caregivers also expressed awareness of more adaptive strategies (e.g., cultivation of positive emotions, acceptance, self-education, and soliciting social and medical support) but had challenges employing them because of their heightened emotional distress.

Conclusions: In response to substantial stressors, family caregivers of patients with SABI attempted to enact various psychological and behavioral coping strategies. They described avoidance and distraction as less helpful than other coping strategies but had difficulty engaging in alternative strategies because of their emotional distress. These findings can directly inform the development of additional resources to mitigate the long-term impact of acute psychological distress among this caregiver population.

Keywords: Coma; Family caregivers; Informal caregivers; Interview.

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Conflict of interest statement

Conflict of interest

Ana-Maria Vranceanu reports serving on the Scientific Advisory Board for the Calm application and royalties from Oxford University Press outside of the submitted work. The other authors report no conflicts of interest.

Figures

**Fig. 1**
Qualitative themes. Themes are subdivided within the domains of (1) psychosocial stressors and (2) coping strategies

See this image and copyright information in PMC

References

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Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma

Affiliations

Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical