Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study

Joanne McPeake; Leanne Boehm; Elizabeth Hibbert; Katrina Hauschildt; Rita Bakhru; Anthony Bastin; Brad Butcher; Tammy Eaton; Wendy Harris; Aluko Hope; James Jackson; Annie Johnson; Janet Kloos; Karen Korzick; Judith McCartney; Joel Meyer; Ashley Montgomery-Yates; Tara Quasim; Andrew Slack; Dorothy Wade; Mary Still; Giora Netzer; Ramona O Hopkins; Mark E Mikkelsen; Theodore Iwashyna; Kimberley Haines; Carla Sevin

doi:10.1136/bmjopen-2021-060454

Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study

BMJ Open. 2022 Sep 27;12(9):e060454. doi: 10.1136/bmjopen-2021-060454.

Authors

Joanne McPeake^{1

2}, Leanne Boehm³, Elizabeth Hibbert⁴, Katrina Hauschildt⁵, Rita Bakhru⁶, Anthony Bastin⁷, Brad Butcher⁸, Tammy Eaton^{9

10}, Wendy Harris¹¹, Aluko Hope¹², James Jackson¹³, Annie Johnson¹⁴, Janet Kloos¹⁵, Karen Korzick¹⁶, Judith McCartney², Joel Meyer¹⁷, Ashley Montgomery-Yates¹⁸, Tara Quasim^{2

19}, Andrew Slack²⁰, Dorothy Wade²¹, Mary Still²², Giora Netzer²³, Ramona O Hopkins^{24

25}, Mark E Mikkelsen²⁶, Theodore Iwashyna²⁷, Kimberley Haines²⁸, Carla Sevin²⁹

Affiliations

¹ Critical Care, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK joanne.mcpeake@glasgow.ac.uk.
² Critical Care, NHS Greater Glasgow and Clyde, Glasgow, UK.
³ School of Nursing, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Department of Physiotherapy, Western Health Foundation, Sunshine, Victoria, Australia.
⁵ Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
⁶ Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁷ Department of Peri-operative Medicine, Barts Health NHS Trust, London, UK.
⁸ Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁹ VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan, Ann Arbor, Michigan, US.
¹⁰ Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, US.
¹¹ Intensive Care Unit, University College London, London, UK.
¹² Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, USA.
¹³ Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University, Nashville, Tennessee, USA.
¹⁴ Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹⁵ Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
¹⁶ Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA.
¹⁷ Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁸ University of Kentucky, Lexington, Kentucky, USA.
¹⁹ School of Medicine, Dentistry and Nursing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK.
²⁰ Department of Critical Care, Guy's and St Thomas' Hospitals NHS Trust, London, UK.
²¹ Critical Care, University College London Hospitals NHS Foundation Trust, London, UK.
²² Critical Care, Emory University Hospital, Atlanta, Georgia, USA.
²³ Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland, USA.
²⁴ Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA.
²⁵ Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA.
²⁶ Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁷ Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan, USA.
²⁸ Department of Physiotherapy, Sunshine Hospital, Melbourne, Victoria, Australia.
²⁹ Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Abstract

Objectives: Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness.

Design: In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections.

Setting: 14 hospital sites in the USA, UK and Australia.

Participants: Patients and caregivers, who had been admitted to critical care from three continents.

Results: 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems.

Conclusions: Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one's social network, economic security and access to healthcare is required following discharge from critical care.

Keywords: adult intensive & critical care; public health; qualitative research.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Caregivers / psychology
Critical Illness* / psychology
Critical Illness* / therapy
Humans
Qualitative Research
Social Determinants of Health*
Survivors / psychology

Abstract

Publication types

MeSH terms

Grants and funding