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  • Open Access

Patients’ primary activities prior to critical illness: how well do clinicians know them and how likely are patients to return to them?

  • 1, 2,
  • 3Email author,
  • 4 and
  • 2, 3, 5
Critical Care201822:340

https://doi.org/10.1186/s13054-018-2283-7

  • Received: 31 October 2018
  • Accepted: 28 November 2018
  • Published:

Admission to the intensive care unit (ICU) can make patients feel anonymous and depersonalized [1]. Knowledge of a patient’s primary activity can mitigate the risk of depersonalization by providing insight into a patient’s values, preferences, and overall function. A patient’s primary activity is defined by how they report spending their free time. This information can be used to engage in shared decision-making, ensuring patients receive care that is goal-concordant based on the feasibility of recovering from their critical illness [2]. Therefore, we conducted a prospective observational study to determine if ICU physicians and nurses could identify their patients’ primary activities. Other objectives included determining if patients were able to return to these activities and the probability of patients surviving based on their primary activity.

From October 2013 to May 2014 [3], enrolled patients (or their surrogates) were asked to identify their primary activity prior to hospitalization (Table 1). Attending physicians and nurses on admission days 3–6 were asked to identify this activity. Patients were followed to 6 months after enrollment to assess if they had survived and returned to their activities.
Table 1

Activity category and frequency, description, ability to return to activity, and survival

Activity category

Description and examples

Full return to activity (%)a

Did not fully return to activity (%)b

Deceased (%)c

Unknown (%)d

Total

Employment

Work, vocation, or employment status

33 (38)

26 (30)

28 (32)

1 (1)e

88

Student

Involves school or academics

2 (67)

1 (33)

0 (0)

0 (0)

3

Physical activity

Physical exercise or strain (i.e., weight lifting, walking)

13 (45)

4 (14)

12 (41)

0 (0)

29

Household

Chores requiring some amount of activity (i.e., cleaning house, shopping)

17 (32)

10 (19)

24 (45)

2 (4)

53

Active

Involves activity but not as main focus (i.e., traveling, fishing)

4 (44)

1 (11)

4 (44)

0 (0)e

9

Social

Engaging with other people (i.e., family time, visiting friends, therapy)

14 (45)

2 (6)

13 (42)

2 (6)

31

Active sedentary

No physical strain but requires active engagement (i.e., arts and crafts, reading)

7 (28)

1 (4)

15 (60)

2 (8)

25

Passive sedentary

No physical strain and no active engagement (i.e., watching TV)

20 (50)

0 (0)

17 (43)

3 (8)

40

Not reported

No activity listed

NA

NA

17 (68)

8 (32)

25

Total

NA

110 (36)

45 (15)

130 (43)

18 (6)

303

aFrequency and percentage of patients within each activity category that were alive and fully returned to their primary activity 6 months post-enrollment in the study. All percentages calculated by dividing the frequency by the activity type’s total

bFrequency and percentage of patients within each activity category that were alive but did not fully return to their primary activity 6 months post-enrollment in the study

cFrequency and percentage of patients within each activity category that were deceased 6 months post-enrollment in the study

dFrequency and percentage of patients within each activity category with unknown vital and/or return to pastime status 6 months post-enrollment in the study

ePercentages do not add to 100% due to decimal place rounding

We found that clinicians had low rates of reporting knowledge of their patients’ primary activities at 13% (38/303) and 12% (35/300) for nurses and physicians, respectively. Patients’ primary activities were reported correctly for 7% (20/303) and 5% (15/300) of patients by nurses and physicians, respectively (Table 1). Among patient reported activities, the most frequent were employment (29%, 88/303) and household work (17%, 53/303). Among survivors 64% (110/173) could perform their primary activity at 6 months, 26% (45/173) could not. For 10% (18/173) of survivors we were unable to confirm if they returned to their primary activity (Table 2).
Table 2

Physician and nurse accuracy in predicting patient primary activities

 

Physicians (n = 300; %)a

Nurses (n = 303; %)a

Correctb

15 (5)

20 (7)

Incorrectc

18 (6)

13 (4)

No patient responsed

2 (1)

5 (2)

No clinician responsee

265 (88)

265 (87)

aTotal number of responses and percentage relative to total patient count

bInstances where clinician and patient primary activity responses agreed

cClinician and patient primary activity responses disagreed

dPatient provided no activity response but the clinician did

eClinician failed to provide an activity response

We believe that knowing how patients spend their time prior to their illness can help in shared decision-making and ensure the delivery of goal-concordant care [4]. In our study, ICU clinicians rarely reported knowing their patient’s primary activity and were correct in only half of those responses, suggesting that ICU clinicians lack an understanding of their patients’ lives prior to critical illness. This is consistent with previous work that assessed physicians’ knowledge of patients’ broader values [5]. The systematic collection of information related to patients’ values may mitigate the risk of depersonalization. Further work is needed to understand the potential impact of whether knowledge of patient activities leads to improved health outcomes and the delivery of goal-concordant care.

Abbreviations

ICU Intensive care unit

Declarations

Acknowledgements

None.

Funding

None.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ contributions

ATG, MCS, AMD, and MED came up with study design, implementation, data analysis, and manuscript preparation. All authors read and approved the final manuscript.

Ethics approval and consent to participate

The University of Pennsylvania institutional review board approved this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Authors’ Affiliations

(1)
Harvard University, Boston, Massachusetts, USA
(2)
Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
(3)
Interdepartmental Division of Critical Care Medicine, University of Toronto, 600 University Ave, Suite 18-232-1, Toronto, ON, M5G 1X5, Canada
(4)
Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
(5)
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

References

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Copyright

© The Author(s). 2018

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