Health Expectations and Quality of Life after Acute Respiratory Failure: A multicenter prospective cohort study.

Jan 30, 2023

Experts: Alison E Turnbull,Emma M Lee,Victor D Dinglas,Sarah Beesley,Somnath Bose,Valerie Banner-Goodspeed,Ramona O Hopkins,James C Jackson,Mustafa Mir-Kasimov,Carla M Sevin,Samuel M Brown,Dale M Needham,

Patients often have high expectations for recovery after critical illness, but the impact of these expectations on their subsequent quality of life (QoL) after serious illnesses has not been empirically evaluated.
Among adult survivors of acute respiratory failure (ARF), are met vs unmet expectations for health associated with self-reported QoL 6 months after discharge?
Prospective longitudinal cohort study enrolling consecutive adult patients with ARF managed in ICUs at five academic medical centers. At hospital discharge, we evaluated participants’ expected health 6 months in the future via a visual analogue scale (VAS) (range: 0-100) with higher scores representing better expected health. At 6-month follow-up, perceived health was assessed using the EQ-5D VAS, and quality of life was assessed using the WHOQOL-BREF instrument. Participants’ health expectations were categorized as “met” when perceived health at six months was no more than eight points lower than their expectation at study enrollment. The primary analysis compared WHOQOL-BREF domain scores (range: 0-100) at 6 months after discharge, in patients with met versus unmet health expectations using the nonparametric Mann-Whitney U test. Secondary analysis modeled WHOQOL-BREF domain scores using multivariable regression, and sensitivity analyses assessed QoL using EQ-5D-5L index values.
In the primary analysis, QoL was significantly better among participants with met vs unmet health expectations across all domains of the WHOQOL-BREF: physical health (estimated difference in scores [IQR] = 19 [12-15], P<0.001), psychological health (12 [6-18], P<0.001), social relationships (6 [0-13], P=0.02), and environmental health (12 [6 – 13], P<0.001). In multivariable regression, the difference between expected and perceived health remained significantly associated with the physical health domain score.
Fulfillment of health expectations is associated with better QoL after ARF, suggesting a mechanism under-pinning successful ICU recovery programs that incorporate normalization and expectation management.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Alison E Turnbull,Emma M Lee,Victor D Dinglas,Sarah Beesley,Somnath Bose,Valerie Banner-Goodspeed,Ramona O Hopkins,James C Jackson,Mustafa Mir-Kasimov,Carla M Sevin,Samuel M Brown,Dale M Needham,

Alison E Turnbull

Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA. Electronic address: turnbull@jhmi.edu.

Emma M Lee

Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Victor D Dinglas

Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.

Sarah Beesley

Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA; Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA; Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA.

Somnath Bose

Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Valerie Banner-Goodspeed

Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Ramona O Hopkins

Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA; Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.

James C Jackson

Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Mustafa Mir-Kasimov

Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA; Salt Lake City Veterans Administration, Salt Lake City, UT, USA.

Carla M Sevin

Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Samuel M Brown

Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA; Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA; Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA.

Dale M Needham

Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.