Recovery following critical illness
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Document TypePhD thesis
Access StatusOpen Access
© 2016 Dr. Kimberley Joy Haines
The legacy of a critical care admission is gaining increased international attention as mortality reduces. Increasingly research is focusing on patient and family-centred outcomes and the ensuing morbidity associated with an intensive care unit (ICU) admission. Within the ICU, decisions are frequently made regarding patient outcomes yet little is known regarding how decision-making processes occur and how patient-centred outcomes are integrated within these decisions. The first part of this thesis focuses on processes occurring within the ICU and investigates the prediction of patient outcomes, what factors are involved in prediction of outcome and how this influences clinical decision-making, and finally what the longer-term outcomes of patients and their caregivers are following ICU. Specifically, the first study establishes how well intensive care clinicians can predict longer-term outcomes for their patients at one-year post ICU discharge. The second study explores how ICU consultants evaluate and conceptualise patient health related quality of life (HRQoL) and physical function to predict outcome and how this is prioritised within their clinical decision-making. The second half of the thesis investigates the actual outcomes for patients and caregivers within Australia. The third study provides invaluable longer-term outcomes data and is the first in Australia to follow-up patients for an extended period of time. This study evaluates HRQoL, psychological dysfunction, physical function and return to work status for survivors at four to five years following ICU discharge. The final two studies provide a systematic review of the literature describing caregiver morbidity and observational data of caregiver outcomes in Australia, as caregivers too are involved in recovery following critical illness.
Keywordscritical illness; long term outcomes; survivors; caregivers; decision-making; prediction of outcome
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