Quality of life following prolonged critical illness: insights from a qualitative approach

Introduction

The measurement of health-related quality of life (HRQoL) among survivors of critical illness has become a prominent feature of our outcomes research. Local research experience suggests that existing measures may fail to capture the broad spectrum of morbidity that survivors experience. The purpose of this research is to explore, through predominantly qualitative methods, critical-illness mediated morbidity among survivors of prolonged critical illness; a group in whom this type of morbidity appears to be most prevalent. An important secondary aim is to explore the contribution of the processes of rehabilitation and recovery to perceptions of HRQoL.

Methods

Survivors who experienced prolonged critical illness (defined as ≥14 days mechanical ventilation) were identified from the Scottish Intensive Care Society Audit Group (SICSAG) database, Wardwatcher^®. Participants were contacted ≤6 months following ICU discharge, and were invited to complete professionally recommended quality-of-life questionnaires (the Short Form 36 and EuroQol-5D) and to participate in a semi-structured interview. Interviews explored everyday experiences of ongoing morbidity and were analysed with regard to their correlation with the domains and scores of the HRQoL questionnaires. Purposive sampling provided clinically important insights into experiences and perceptions of health and pre-existing morbidity and, importantly, the processes of rehabilitation and recovery; that is, through comparison of (i) patients with/without appreciable pre-existing disease and (ii) patients receiving ward-based rehabilitation with those who receive formalised rehabilitation in dedicated facilities.

Preliminary results

Ten of the required 40 interviewees have so far been recruited. Preliminary analysis confirms that survivors experience a range of morbidity not well captured by professionally recommended measures, and that pre-existing disease is an important factor in both coping with new morbidity superimposed by critical illness, and in marshalling support. The process of rehabilitation appears to have important effects on perceptions of recovery, self-management strategies, and perceptions of HRQoL.

Conclusion

This qualitative enquiry has already provided, and will continue to provide, new and clinically relevant insights into patients' experiences of morbidity, the processes of rehabilitation, recovery and perceived HRQoL following discharge into the community.