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Citation
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Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas IS, Van Pelt D, Burnham EL, Moss M. Ann. Am. Thorac. Soc. 2017; 14(7): 1154-1161. |
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Affiliation
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University of Colorado/ Emory University, Division of Pulmonary Sciences and Critical Care Medicine , 4200 E 9th Ave C272 Room 5525 , Denver, Colorado, United States , 80262 ; marc.moss@ucdenver.edu. |
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Abstract
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RATIONALE: Alcohol misuse is common in patients admitted to the intensive care unit (ICU) but there is currently no evidence-based approach to address drinking in ICU survivors.
OBJECTIVES: We sought to describe the experience of ICU survivors with alcohol misuse during their hospitalization and the 3 months following hospital discharge in order to inform an alcohol specific intervention for this unique population.
METHODS: We conducted a descriptive qualitative study of ICU survivors from medical ICUs in three separate hospitals with a positive screening result on the Alcohol Use Disorders Identification Test. Semi-structured interviews were conducted 3 months following hospital discharge in patients. Patients were also allowed to nominate up to two friends or family members for enrollment in order to provide additional perspective on the patient's experience.
RESULTS: We enrolled 50 patients and 22 of their friends and/or family members. The average APACHE II score was 23, 80% of patients were male, and the average age was 50; 70% of patients and 77% of friends/family members completed the semi-structured interview 3 months after hospital discharge. We identified three domains that could inform an alcohol-specific intervention, each with multiple themes: the context of decision making in the hospital (anxiety and depression, critical illness as a catalyst, delirium and cognitive impairment); patient-provider interactions (autonomy, failure and opportunities to build a therapeutic alliance); and the transition from hospital to home (lack of screening for depression and anxiety, social network support for drinking, social isolation, social network support for abstinence, lack of available and affordable treatment, and negative experiences with Alcoholics Anonymous).
CONCLUSIONS: An alcohol intervention for ICU survivors would account for the context in which patients are making a decision about their drinking and optimize the patient-provider interaction. Contrary to current paradigms that focus on addressing alcohol consumption only during a hospitalization, an intervention for ICU survivors should continue as patients transition from the hospital to home. Primary source of funding. National Institutes of Health K23 AA 021814.
Language: en |