Discussion Guide for the McPeake Article

Critical illness survivors report ongoing physical, emotional, and cognitive impairments after intensive care unit (ICU) discharge, known as post–intensive care syndrome (PICS). Those affected by PICS, which can last for months to years, often require informal caregiving support and subsequent hospitalizations that burden family and health care systems. Despite global development of ICU recovery programs aimed at assisting PICS patients and their caregivers, their effectiveness remains inconsistent. Issues arise from various factors, such as insufficient integration with community services, neglect of preexisting chronic conditions, and limited focus on patients’ social outcomes affecting recovery. Individualized patient goals often differ from clinician-defined objectives, so it is crucial to identify these patient-prioritized goals to improve ICU recovery interventions.To inform and optimize future models of ICU recovery services, the investigators comprehensively explored patient-defined rehabilitation goals from survivors enrolled in a multicenter ICU recovery program.Investigators conducted a longitudinal cohort study under the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) program at 3 Scottish hospitals from 2016 to 2019. Critical care survivors were contacted 4 to 12 weeks after discharge if they had received level 3 critical care (advanced respiratory support or multiorgan support) or more than 7 consecutive days of level 2 care (basic support for 1 organ system or extended postoperative observation). Exclusions included terminal illness, traumatic brain injury, psychiatric inpatient status, or absence of a valid ICU-linkage identifier. During 5 weekly sessions, participants established 1 to 6 personal recovery goals with staff. Goals, demographics, ICU variables, and the Scottish Index of Multiple Deprivation quintile were recorded for team reviews and follow-ups at 3 and 12 months. The intervention involved evaluations by an ICU physician and nurse, pharmacist-led medication optimization, physiotherapy assessments, neuropsychology support, peer assistance, and community organization connections, incorporating input from patients and caregivers. Two critical-care nurse researchers independently coded the data, created a unified framework, and organized excerpts into a thematic matrix. Two other researchers reviewed coding decisions, and an ICU bedside nurse provided validation, resulting in a framework containing categories of patient-defined goals.Investigators analyzed data from 151 ICU survivors (55% male; median age, 58 years) from 3 Scottish hospitals. They had a median ICU stay of 11 days and moderate to high mortality risk. Multimorbidity was present in 72%, and 42% lived in the most socioeconomically deprived communities. During the 5-week InS:PIRE program, 134 patients (88.7%) set 314 personal recovery goals (median 2, IQR 1-3) in 5 categories: physical rehabilitation (107 goals, 34.1%), social activities (54 goals, 17.2%), health management (51 goals, 16.2%), emotional concerns (51 goals, 16.2%; 49% of those concerned sleep), and education or employment pursuits (51 goals, 16.2%). Overall, ICU survivors prioritized restoring physical function, reengaging socially, managing health issues, addressing psychological distress, and resuming meaningful roles.The variety of goals that ICU survivors identified indicates that post-ICU services should be multidisciplinary and align medical management with each patient’s priorities, rather than focusing solely on the aftereffects of critical illness. Future intervention trials should incorporate patient-defined goals from the planning stage and assess whether comprehensive, person-centered programs yield better long-term outcomes for survivors.Joanne McPeake, PhD, RN, trained as a nurse at the University of Glasgow, graduating in 2004, and pursued a career in intensive care. She loved being able to “look after every part of the patient.” While working bedside shifts, McPeake conducted a mixed-methods PhD study involving 700 ICU patients with alcohol-related conditions. That experience deeply shaped her perspective: many survivors “were going home, and their lives were shattered,” demonstrating to her that successful critical care must extend beyond mere survival to emphasize long-term recovery.Driven by these insights, McPeake codesigned InS:PIRE. Its implementation was challenging, as integrating ICU and community services required substantial creativity and commitment. McPeake engaged community welfare advisers and clinical psychologists who initially volunteered, with support from ICU teams who adjusted their schedules to participate. The successful pilot study expanded, and InS:PIRE now operates in about one-third of Scottish ICUs. Now at the University of Cambridge, McPeake is refining the model to better serve survivors with multimorbidity and those from socio-economically disadvantaged backgrounds.The InS:PIRE program illustrates clearly that post-ICU care must include more than physical rehabilitation. As McPeake notes, “the interplay with people’s chronic conditions was really important; self-managing those conditions often caused the most problems.” To address these needs, InS:PIRE integrates welfare and employment advisers into the recovery process, enabling patients to secure financial stability and regain purpose through meaningful social engagement. A concise clinical debriefing by an ICU nurse and physician helps fill distressing memory gaps and alleviates anxiety for survivors. Informal peer support, facilitated by former patients, creates safe and supportive spaces for recovery. McPeake stresses that merging ICU expertise with community resources, although challenging, significantly reduces hospital readmissions, supports caregivers effectively, and helps bridge the health-inequality gap that often widens following critical illness.This feature briefly describes the personal journey and background story of the EBR article’s lead investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.Joanne McPeake, PhD, RN, sees nursing and research as fundamentally interconnected: “Research is about finding the right treatment for the right patient at the right time, and that’s the core of nursing.” Her professional journey reflects this philosophy, from balancing clinical night shifts while earning her PhD to developing and scaling up the Intensive Care Syndrome: Promoting Independence and Return to Employment program across Scotland. McPeake emphasizes the importance of building collaborative, patient-centered teams of colleagues willing to embrace challenges. Central to her research has always been addressing social inequalities and ensuring vulnerable patient groups and their families receive meaningful support and care. McPeake advises novice researchers, “Do the clinical question that really keeps you alive, gets you going, gets you motivated.” She firmly believes this approach will lead to sustained funding, strong collaborations, and ultimately impactful improvements in patient care.