Patient-important upper gastrointestinal bleeding in the ICU: A mixed-methods study of patient and family perspectives

Meredith G Vanstone; Karla Krewulak; Shipra Taneja; Marilyn Swinton; Kirsten Fiest; Karen E A Burns; Sylvie Debigare; Joanna C Dionne; Gordon Guyatt; John C Marshall; John G Muscedere; Adam M Deane; Simon Finfer; John A Myburgh; Audrey Gouskos; Bram Rochwerg; Ian Ball; Tina Mele; Daniel J Niven; Shane W English; Madeleine Verhovsek; Deborah J Cook; Canadian Critical Care Trials Group

doi:10.1016/j.jcrc.2024.154761

Patient-important upper gastrointestinal bleeding in the ICU: A mixed-methods study of patient and family perspectives

J Crit Care. 2024 Jun:81:154761. doi: 10.1016/j.jcrc.2024.154761. Epub 2024 Mar 5.

Authors

Meredith G Vanstone¹, Karla Krewulak², Shipra Taneja¹, Marilyn Swinton³, Kirsten Fiest², Karen E A Burns⁴, Sylvie Debigare⁵, Joanna C Dionne⁶, Gordon Guyatt⁷, John C Marshall⁸, John G Muscedere⁹, Adam M Deane¹⁰, Simon Finfer¹¹, John A Myburgh¹², Audrey Gouskos¹³, Bram Rochwerg⁶, Ian Ball¹⁴, Tina Mele¹⁵, Daniel J Niven², Shane W English¹⁶, Madeleine Verhovsek³, Deborah J Cook¹⁷; Canadian Critical Care Trials Group

Affiliations

¹ Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
² Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
⁴ Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada.
⁵ Patient and Family Partnership Committee, Commission Scolaire Central Québec, Canadian Critical Care Trials Group, Canada.
⁶ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada.
⁷ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
⁸ Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada; Department of Surgery, Unity Health Toronto, University of Toronto, Canada.
⁹ Department of Critical Care Medicine, Queens University, Kingston Health Sciences Center.
¹⁰ Department of Critical Care, University of Melbourne, Melbourne Medical School, Victoria, Australia.
¹¹ Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, School of Public Health, Imperial College London, London, England, United Kingdom.
¹² Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
¹³ Patient and Family Advisory Committee and Steering Committee representative, FAST-NAWC Trial, University of Toronto, Canada.
¹⁴ Department of Medicine, Western University, London, Ontario, Canada.; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada.
¹⁵ Department of Critical Care Medicine, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada.
¹⁶ Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁷ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, St. Joseph's Healthcare Hamilton. Electronic address: debcook@mcmaster.ca.

PMID: 38447306
DOI: 10.1016/j.jcrc.2024.154761

Abstract

Introduction: The objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial.

Design: This was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding.

Setting: Canada and the United States.

Participants: 51 ICU survivors and family members of ICU patients.

Results: Participants considered gastrointestinal bleeding to be important if it resulted in death, disability, or prolonged hospitalization. The following also signaled patient-important upper gastrointestinal bleeding: blood transfusion, vasopressors, endoscopy, CT-angiography, or surgery. Whether an intervention evinced concern depended on its effectiveness, side-effects, invasiveness and accessibility; contextual influences included participant familiarity and knowledge of interventions and trust in the clinical team.

Conclusions: Survivors of critical illness and family members described patient-important upper gastrointestinal bleeding differently than current definitions of clinically-important upper gastrointestinal bleeding.

Keywords: Critical care; Gastrointestinal bleeding; Intensive care unit; Patient and family centered care; Patient engagement; Patient-oriented research; Randomized trial.

Publication types

Multicenter Study

MeSH terms

Critical Care
Critical Illness*
Family
Gastrointestinal Hemorrhage
Humans
Intensive Care Units*