Nidhi G. Huff|Nandita R. Nadig|Dee W. Ford|Christopher E. Cox
Therapeutic Alliance between the Caregivers of Critical Illness Survivors and Intensive Care Unit Clinicians
Pulmonary and Critical Care Associates|Medical University of South Carolina|Medical University of South Carolina|Duke University|Pulmonary and Critical Care Associates
rationale therapeutic alliance novel measure multifaceted caregiverclinician relationship promising intervention target improving patientcentered outcomeshowever therapeutic alliance studied intensive care unit icu settingobjectives explore relationships among caregiverreported therapeutic alliance psychological distress well patient caregiver icu clinician factors methodsin crosssectional study enrolled consecutive patient caregivers mechanically ventilated patients discharged icus duke university medical university south carolina hospitals december 2013 august 2014 measurements main resultscaregivers completed inperson hospitalbased interview included measures therapeutic alliance icu physicians human connection scale well patient centeredness care symptoms depression anxiety posttraumatic stress decisional conflict quality communicationwe performed multivariate regression characterize associations human connection scale scores key variablesa total 56 caregivers included exploratory analysespatients largely disabled 47 medicare insured 53caregivers highly educated generally high therapeutic alliance median 55 interquartile range 4858 icu clinicianstherapeutic alliance strongly correlated patient centeredness r 078 poorly correlated psychological distress r 02stepwise multivariate modeling revealed higher therapeutic alliance associated fewer baseline patient comorbidities well caregiver report greater trust icu team better quality communication less decisional conflict p 0012conclusions therapeutic alliance encompasses measures trust communication cooperation intuitive forming good working relationshiptherapeutic alliance among icu caregivers strongly associated modifiable nonmodifiable factorsour exploratory study highlights new intervention targets may inform strategies improving quality caregiverclinician interaction