Skip to main content
Top
Published in: Intensive Care Medicine 6/2019

01-06-2019 | Post-Traumatic Stress Disorder | Original

Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study

Authors: Jeena Moss, Michael B. Roberts, Lisa Shea, Christopher W. Jones, Hope Kilgannon, Donald E. Edmondson, Stephen Trzeciak, Brian W. Roberts

Published in: Intensive Care Medicine | Issue 6/2019

Login to get access

Abstract

Purpose

We tested the hypothesis that, during a life-threatening medical emergency, patient perception of healthcare provider (HCP) compassion is associated with the subsequent development of post-traumatic stress disorder (PTSD) symptoms.

Methods

Prospective cohort study in the emergency department (ED) of an urban academic medical center. We included adult patients presenting with a life-threatening medical emergency, defined as respiratory or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. We measured patient perception of HCP compassion in the ED using the Consultation and Relational Empathy (CARE) measure, a validated 40-point scale. Blinded to clinical outcomes (including the CARE measure), we assessed PTSD symptoms 1 month post-discharge using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5.

Results

Of the 99/113 (88%) patients who completed follow-up, 25% (95% CI 17–35%) had PTSD symptoms at 1 month. In a multivariable model adjusting for potential confounders (e.g. severity of illness score in ED, need for intensive care unit admission, ED overcrowding, and family member emotional support in the ED), patient perception of greater HCP compassion in the ED was independently associated with lower PTSD symptoms at 1 month [odds ratio 0.93 (95% CI 0.89–0.98)]. A one-point increase in the CARE measure was associated with a 7% decrease in the odds of developing PTSD symptoms.

Conclusions

PTSD symptoms are common among ED patients with life-threatening medical emergencies. Patient perception of greater HCP compassion during the emergency is independently associated with lower risk of developing PTSD symptoms.
Appendix
Available only for authorised users
Literature
1.
go back to reference American Psychiatric Association (2013) Diagnostic and Statistical Manual–5th Edition (DMS-5). American Psychiatric Association, Washington American Psychiatric Association (2013) Diagnostic and Statistical Manual–5th Edition (DMS-5). American Psychiatric Association, Washington
2.
go back to reference Wade D, Hardy R, Howell D, Mythen M (2013) Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiol 79:944–963PubMed Wade D, Hardy R, Howell D, Mythen M (2013) Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiol 79:944–963PubMed
3.
go back to reference Pacella ML, Hruska B, Delahanty DL (2013) The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord 27:33–46CrossRefPubMed Pacella ML, Hruska B, Delahanty DL (2013) The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord 27:33–46CrossRefPubMed
4.
go back to reference Zatzick D, Jurkovich GJ, Rivara FP, Wang J, Fan MY, Joesch J, Mackenzie E (2008) A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Ann Surg 248:429–437PubMed Zatzick D, Jurkovich GJ, Rivara FP, Wang J, Fan MY, Joesch J, Mackenzie E (2008) A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Ann Surg 248:429–437PubMed
5.
go back to reference Walker EA, Katon W, Russo J, Ciechanowski P, Newman E, Wagner AW (2003) Health care costs associated with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry 60:369–374CrossRefPubMed Walker EA, Katon W, Russo J, Ciechanowski P, Newman E, Wagner AW (2003) Health care costs associated with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry 60:369–374CrossRefPubMed
6.
go back to reference Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y (2012) Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLoS One 7:e38915CrossRefPubMedPubMedCentral Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y (2012) Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLoS One 7:e38915CrossRefPubMedPubMedCentral
7.
go back to reference Edmondson D, Rieckmann N, Shaffer JA, Schwartz JE, Burg MM, Davidson KW, Clemow L, Shimbo D, Kronish IM (2011) Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality. J Psychiatr Res 45:1621–1626CrossRefPubMedPubMedCentral Edmondson D, Rieckmann N, Shaffer JA, Schwartz JE, Burg MM, Davidson KW, Clemow L, Shimbo D, Kronish IM (2011) Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality. J Psychiatr Res 45:1621–1626CrossRefPubMedPubMedCentral
8.
go back to reference Lown BA, Rosen J, Marttila J (2011) An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Aff (Millwood) 30:1772–1778CrossRef Lown BA, Rosen J, Marttila J (2011) An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Aff (Millwood) 30:1772–1778CrossRef
9.
go back to reference Trzeciak S, Roberts BW, Mazzarelli AJ (2017) Compassionomics: hypothesis and experimental approach. Med Hypotheses 107:92–97CrossRefPubMed Trzeciak S, Roberts BW, Mazzarelli AJ (2017) Compassionomics: hypothesis and experimental approach. Med Hypotheses 107:92–97CrossRefPubMed
10.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Ann Intern Med 147:573–577CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Ann Intern Med 147:573–577CrossRef
11.
go back to reference Bikker AP, Fitzpatrick B, Murphy D, Mercer SW (2015) Measuring empathic, person-centred communication in primary care nurses: validity and reliability of the consultation and relational empathy (CARE) measure. BMC Fam Pract 16:149CrossRefPubMedPubMedCentral Bikker AP, Fitzpatrick B, Murphy D, Mercer SW (2015) Measuring empathic, person-centred communication in primary care nurses: validity and reliability of the consultation and relational empathy (CARE) measure. BMC Fam Pract 16:149CrossRefPubMedPubMedCentral
12.
go back to reference Mercer SW, Maxwell M, Heaney D, Watt GC (2004) The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 21:699–705CrossRefPubMed Mercer SW, Maxwell M, Heaney D, Watt GC (2004) The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 21:699–705CrossRefPubMed
13.
go back to reference Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC (2005) Relevance and practical use of the consultation and relational empathy (CARE) measure in general practice. Fam Pract 22:328–334CrossRefPubMed Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC (2005) Relevance and practical use of the consultation and relational empathy (CARE) measure in general practice. Fam Pract 22:328–334CrossRefPubMed
14.
go back to reference Mercer SW, Murphy DJ (2008) Validity and reliability of the CARE measure in secondary care. Clin Gov Int J 13:269–283CrossRef Mercer SW, Murphy DJ (2008) Validity and reliability of the CARE measure in secondary care. Clin Gov Int J 13:269–283CrossRef
15.
go back to reference Homma K, Chang B, Shaffer J, Toledo B, Hefele B, Dalrymple N, Edmondson D (2016) Association of social support during emergency department evaluation for acute coronary syndrome with subsequent posttraumatic stress symptoms. J Behav Med 39:823–831CrossRefPubMedPubMedCentral Homma K, Chang B, Shaffer J, Toledo B, Hefele B, Dalrymple N, Edmondson D (2016) Association of social support during emergency department evaluation for acute coronary syndrome with subsequent posttraumatic stress symptoms. J Behav Med 39:823–831CrossRefPubMedPubMedCentral
16.
go back to reference Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frackelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG (2004) Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med 11:38–50CrossRefPubMed Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frackelton M, Schwab R, Stair TO, Vicellio P, Levy D, Brautigan M, Johnson A, Nick TG (2004) Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med 11:38–50CrossRefPubMed
17.
go back to reference Murray SB, Bates DW, Ngo L, Ufberg JW, Shapiro NI (2006) Charlson Index is associated with one-year mortality in emergency department patients with suspected infection. Acad Emerg Med 13:530–536CrossRefPubMed Murray SB, Bates DW, Ngo L, Ufberg JW, Shapiro NI (2006) Charlson Index is associated with one-year mortality in emergency department patients with suspected infection. Acad Emerg Med 13:530–536CrossRefPubMed
18.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829CrossRefPubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829CrossRefPubMed
19.
go back to reference Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM (2013) Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J 166:806–814CrossRefPubMed Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM (2013) Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J 166:806–814CrossRefPubMed
20.
go back to reference Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL (2015) The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 28:489–498CrossRefPubMed Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL (2015) The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 28:489–498CrossRefPubMed
21.
go back to reference Bovin MJ, Marx BP, Weathers FW, Gallagher MW, Rodriguez P, Schnurr PP, Keane TM (2016) Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychol Assess 28:1379–1391CrossRefPubMed Bovin MJ, Marx BP, Weathers FW, Gallagher MW, Rodriguez P, Schnurr PP, Keane TM (2016) Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychol Assess 28:1379–1391CrossRefPubMed
22.
go back to reference Roberts MB, Glaspey LJ, Mazzarelli A, Jones CW, Kilgannon HJ, Trzeciak S, Roberts BW (2018) Early interventions for the prevention of posttraumatic stress symptoms in survivors of critical illness: a qualitative systematic review. Crit Care Med 46:1328–1333CrossRefPubMed Roberts MB, Glaspey LJ, Mazzarelli A, Jones CW, Kilgannon HJ, Trzeciak S, Roberts BW (2018) Early interventions for the prevention of posttraumatic stress symptoms in survivors of critical illness: a qualitative systematic review. Crit Care Med 46:1328–1333CrossRefPubMed
23.
go back to reference Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP (2013) The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at http://www.ptsd.va.gov. Accessed 01 Jan 2018 Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP (2013) The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at http://​www.​ptsd.​va.​gov. Accessed 01 Jan 2018
24.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMed Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMed
25.
go back to reference Maslove DM, Leisman DE (2019) Causal Inference from Observational Data: New Guidance From Pulmonary, Critical Care, and Sleep Journals. Crit Care Med 47:1–2CrossRefPubMed Maslove DM, Leisman DE (2019) Causal Inference from Observational Data: New Guidance From Pulmonary, Critical Care, and Sleep Journals. Crit Care Med 47:1–2CrossRefPubMed
26.
go back to reference Edmondson D, Shimbo D, Ye S, Wyer P, Davidson KW (2013) The association of emergency department crowding during treatment for acute coronary syndrome with subsequent posttraumatic stress disorder symptoms. JAMA Intern Med 173:472–474CrossRefPubMedPubMedCentral Edmondson D, Shimbo D, Ye S, Wyer P, Davidson KW (2013) The association of emergency department crowding during treatment for acute coronary syndrome with subsequent posttraumatic stress disorder symptoms. JAMA Intern Med 173:472–474CrossRefPubMedPubMedCentral
27.
go back to reference Griffiths J, Fortune G, Barber V, Young JD (2007) The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med 33:1506–1518CrossRefPubMed Griffiths J, Fortune G, Barber V, Young JD (2007) The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med 33:1506–1518CrossRefPubMed
28.
go back to reference Davydow DS, Zatzick D, Hough CL, Katon WJ (2013) A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission. Gen Hosp Psychiatry 35:226–232CrossRefPubMedPubMedCentral Davydow DS, Zatzick D, Hough CL, Katon WJ (2013) A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical-surgical intensive care unit admission. Gen Hosp Psychiatry 35:226–232CrossRefPubMedPubMedCentral
29.
go back to reference Wiedemar L, Schmid JP, Muller J, Wittmann L, Schnyder U, Saner H, von Kanel R (2008) Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction. Heart Lung 37:113–121CrossRefPubMed Wiedemar L, Schmid JP, Muller J, Wittmann L, Schnyder U, Saner H, von Kanel R (2008) Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction. Heart Lung 37:113–121CrossRefPubMed
30.
go back to reference van der Kolk BA, Fisler R (1995) Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. J Trauma Stress 8:505–525CrossRefPubMed van der Kolk BA, Fisler R (1995) Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. J Trauma Stress 8:505–525CrossRefPubMed
31.
go back to reference McCanlies EC, Sarkisian K, Andrew ME, Burchfiel CM, Violanti JM (2017) Association of peritraumatic dissociation with symptoms of depression and posttraumatic stress disorder. Psychol Trauma 9:479–484CrossRefPubMed McCanlies EC, Sarkisian K, Andrew ME, Burchfiel CM, Violanti JM (2017) Association of peritraumatic dissociation with symptoms of depression and posttraumatic stress disorder. Psychol Trauma 9:479–484CrossRefPubMed
32.
go back to reference Gidron Y, Gal R, Freedman S, Twiser I, Lauden A, Snir Y, Benjamin J (2001) Translating research findings to PTSD prevention: results of a randomized-controlled pilot study. J Trauma Stress 14:773–780CrossRefPubMed Gidron Y, Gal R, Freedman S, Twiser I, Lauden A, Snir Y, Benjamin J (2001) Translating research findings to PTSD prevention: results of a randomized-controlled pilot study. J Trauma Stress 14:773–780CrossRefPubMed
33.
go back to reference Edmondson D, Richardson S, Fausett JK, Falzon L, Howard VJ, Kronish IM (2013) Prevalence of PTSD in survivors of stroke and transient ischemic attack: a meta-analytic review. PLoS ONE 8:e66435CrossRefPubMedPubMedCentral Edmondson D, Richardson S, Fausett JK, Falzon L, Howard VJ, Kronish IM (2013) Prevalence of PTSD in survivors of stroke and transient ischemic attack: a meta-analytic review. PLoS ONE 8:e66435CrossRefPubMedPubMedCentral
34.
go back to reference Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG (2007) “Could this be something serious?” Reassurance, uncertainty, and empathy in response to patients’ expressions of worry. J Gen Intern Med 22:1731–1739CrossRefPubMedPubMedCentral Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG (2007) “Could this be something serious?” Reassurance, uncertainty, and empathy in response to patients’ expressions of worry. J Gen Intern Med 22:1731–1739CrossRefPubMedPubMedCentral
Metadata
Title
Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study
Authors
Jeena Moss
Michael B. Roberts
Lisa Shea
Christopher W. Jones
Hope Kilgannon
Donald E. Edmondson
Stephen Trzeciak
Brian W. Roberts
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 6/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05601-5

Other articles of this Issue 6/2019

Intensive Care Medicine 6/2019 Go to the issue