Intervention Research

INTERVENTION RESEARCH

Background

In a recent review, Shudy et al1 have pointed out that despite the mounting evidence that a significant minority families suffer long term negative psychological consequences after a child's admission to PICU, there is little information available on effective intervention with parents or children in this situation. A notable exception is the work of Melnyk et al2 who have demonstrated that their COPE program improves coping in both mothers and young children after an admission to critical care.

In the adult literature there are promising reports of patients' reactions to PICU diaries3 and an increasing number of units in the UK are offering follow-up clinic appointments for patients and relatives4 which are reportedly well received, but neither of these forms of intervention have been fully evaluated.

Research to date

Following the finding in an earlier study that the majority of parents would on reflection have appreciated a chance to meet up with PICU staff to discuss their child's admission5,  it was decided to offer such an appointment prospectively in a randomised controlled trial in order to examine whether such an intervention would impact on parents' psychological symptoms.

Although only a minority of the 67 families allocated to the intervention condition attended the appointment, statistical analyses revealed that the offer of an appointment was associated with a significant reduction in depression and post-traumatic stress symptoms for a sub-group of parents who had reported the highest levels of stress during admission6.

Ideas for future research

A replication of the RCT described above with a larger sample would determine whether there was an effect of the follow-up clinic intervention on parents' well-being.

In terms of an intervention directed at the children themselves, given the positive reaction clinically seen to the use of individually designed story books at St George's Hospital PICU, it might be possible to evaluate this form of intervention in a prospective RCT.

 eg Storybook for child after PICU link

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References

  1. Shudy et al (2005)
  2. Melnyk et al (2004)
  3. Backman & Walther (2001)
  4. Griffiths et al (2006)
  5. Colville GA, Cream PR and Gracey D. Parents’ views on follow up after Paediatric Intensive Care. British Journal of Anaesthesia 90: (4) 548-9
  6. Colville et al (2010)  and see also Evaluation of a PICU follow up clinic: it's good to talk!, presented at  Royal Holloway University of London in Sept 2009  ppt/handout
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