Uncertainty and Expectation Formation in Acute Respiratory Failure Survivors

PROJECT SUMMARY/ABSTRACT In-hospital mortality rates for acute respiratory failure (ARF) have improved, resulting in increasing numbers of ARF survivors. While their survival is indicative of major clinical advances in care, many of these individuals are left with long-term physical, cognitive, and psychological sequelae of their critical illness, leading to reduced quality of life (QoL). Interventions in the post-intensive care unit (ICU) setting have struggled to make headway on improving QoL and there is an urgent need to understand relevant modifiable factors. Evidence suggests that health expectations and bothersome levels of uncertainty about future health are two such factors. The unifying goal of this proposal is to understand key factors associated with bothersome uncertainty and expectation formation in ARF survivors at hospital discharge, as these factors are potential targets for intervention. We will study a cohort of 65 ARF survivors to characterize the prevalence of bothersome uncertainty and test the hypothesis that it is associated with perceived quality of healthcare provider communication (Aim 1). We will also perform at least 25 semi-structured interviews with a purposively selected cohort to further elucidate the experiences which shaped ARF survivors’ level of uncertainty and identify the sources of information that most influenced their expectations (Aim 2). This work will be performed leveraging resources allocated to an existing parent study (1R01HL163660), to ensure feasibility and success within the time period described in this proposal. This work will fill a gap in knowledge about how bothersome uncertainty and health expectations develop at the time of hospital discharge after ARF. The results will be applicable to the development of post-ICU interventions addressing expectations and uncertainty. This study will provide the applicant with essential preliminary data for a future K-level grant and necessary training in clinical and qualitative research skills including conduct of a cohort study, collection of patient-reported outcomes, statistical analysis of quantitative data, and conduct and analysis of qualitative semi-structured interviews. This work will be foundational for the applicant’s long-term goal of becoming an independently funded clinician investigator working to improve the care of patients in the ICU.