Exploring patients' and family members’ perspectives on intensive care unit experiences through unsolicited feedback: A qualitative content analysis

BACKGROUND: Intensive care unit (ICU) stays are profound and distressing experiences for critically ill patients and their family members, often resulting in physical, psychological, cognitive, and social sequelae. Existing knowledge stems largely from structured interviews or questionnaires addressing predefined questions, potentially overlooking how individuals spontaneously and autonomously choose to express their experiences without being prompted. OBJECTIVE: This study was conducted to explore the content of unsolicited feedback from former critically ill patients and family members, offering a valuable source of unique, self-determined, and underexplored insights into individuals' spontaneously expressed experiences, perceptions of care, and voiced concerns. METHODS: An inductive qualitative research design was selected. Unsolicited feedback (written), spontaneously addressed directly to ICU healthcare professionals by former critically ill patients and family members, or indirectly via hospital ombudsman, was collected. FINDINGS: A total of 83 unsolicited feedbacks were received during a period of 27 months. Of these, 39 were direct unsolicited feedback and included in the qualitative analysis. Direct unsolicited feedback was most frequently submitted by family members and primarily consisted of letters of appreciation and cards notifying of a patient's demise. The analysis led to the identification of three main categories: (i) acknowledging meaningful connections; (ii) perceiving high clinical competence; and (iii) dealing with a highly challenging situation. A total of 44 indirect unsolicited feedbacks were received via the hospital ombudsman, and these were predominantly negative in nature. CONCLUSIONS: These feedbacks may support meaning-making processes following critical illness by enabling individuals to express emotions, acknowledge care received or voice concerns, and integrate highly challenging situations, thereby contributing to a sense of closure. Thus, unsolicited feedback can be understood as a self-determined expression of ongoing meaning-making.