The effectiveness of written and/or verbal critical care discharge information to support early critical illness recovery: a narrative critical review

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Description/Abstract

Background
Discharge from critical care can lead to substantial distress and uncertainty for patients and relatives. Providing information may alleviate or reduce this distress, but the best way to do this is unclear.

Aims
This review assesses research evidence addressing the effectiveness of written and/or verbal information for adult patients or their relatives upon discharge from critical care to identify the factors likely to influence its impact on physical and psychological outcomes.

Methods
We undertook a narrative critical review of published research. Medline, Embase, PyschInfo, Web of Science, The British Nursing Index and the Cochrane Library as well as key web sites and reference lists were searched for relevant research published between 1990-2011,which explored the impact of written or verbal critical care discharge information. Methodological appraisal of studies was undertaken using tools provided by the Critical Appraisal Skills Programme.

Results
We found eight publications reporting four independent studies: one multi-centre randomised controlled trial, two quasi-experimental studies and a descriptive qualitative study. In total 133 patients, 193 relatives and 33 nurses were studied. Results showed beneficial physical effects for patients from using a self-help manual, and improved knowledge and increased satisfaction for relatives for combined written and verbal information. Evidence on anxiety was mixed and the value of a written booklet alone was unclear. However the evidence base was of low overall quality.

Implications for practice
Critical care discharge information should:
• Combine written and verbal information
• Take account of physical and psychological vulnerabilities
• Be individualized and flexible
• Incorporate opportunities for user participation and reflection

Conclusions
Current evidence suggests that individualised information incorporating user participation and opportunities for reflection may improve the psycho-social well-being of both patients and relatives. Further development and evaluation of strategies that combine effective verbal and written information is required.