Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting - results from a qualitative sub-study of the PICTURE trial

TY - JOUR

T1 - Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting - results from a qualitative sub-study of the PICTURE trial

AU - Sanftenberg, Linda

AU - Beutel, Antina

AU - Friemel, Chris Maria

AU - Kosilek, Robert Philipp

AU - Schauer, Maggie

AU - Elbert, Thomas

AU - Reips, Ulf-Dietrich

AU - Gehrke-Beck, Sabine

AU - Schubert, Tomke

AU - Schmidt, Konrad

AU - Gensichen, Jochen

AU - PICTURE Study Group

AU - Brettschneider, Christian

AU - König, Hans-Helmut

AU - Gallinat, Jürgen

AU - Hardt, Hanna

AU - Lühmann, Dagmar

AU - Oltrogge-Abiry, Jan Hendrik

AU - Scherer, Martin

N1 - © 2023. The Author(s).

PY - 2023/5/6

Y1 - 2023/5/6

N2 - BACKGROUND: The results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study.METHODS: Qualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories.RESULTS: The study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention.CONCLUSION: The primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach.TRIAL REGISTRATION: The main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.

AB - BACKGROUND: The results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study.METHODS: Qualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories.RESULTS: The study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention.CONCLUSION: The primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach.TRIAL REGISTRATION: The main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.

KW - Humans

KW - Male

KW - Female

KW - Middle Aged

KW - Psychosocial Intervention

KW - Physician-Patient Relations

KW - Intensive Care Units

KW - Emotions

KW - Primary Health Care

U2 - 10.1186/s12875-023-02046-0

DO - 10.1186/s12875-023-02046-0

M3 - SCORING: Journal article

C2 - 37149603

VL - 24

SP - 113

JO - BMC PRIM CARE

JF - BMC PRIM CARE

SN - 1471-2296

IS - 1

ER -