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Models of Peer Support to Remediate Post-Intensive Care Syndrome

A Report Developed by the Society of Critical Care Medicine Thrive International Peer Support Collaborative*

McPeake, Joanne, PhD, MSc, BN (Hons), RGN1,2; Hirshberg, Eliotte L., MD, MS3,4,5; Christie, Leeann M., MSN, RN6,7; Drumright, Kelly, RN, MSN, CNL7; Haines, Kimberley, PhD, BHSc (Physiotherapy)8,9; Hough, Catherine L., MD, MSc10; Meyer, Joel, BM, BCh, DM, MRCP, AHEA, FFICM11; Wade, Dorothy, PhD, MSc12; Andrews, Adair, RN, MATD13; Bakhru, Rita, MD, MS14; Bates, Samantha, RN8; Barwise, John A., MBChB7,15; Bastarache, Julie, MD7,15; Beesley, Sarah J., MD16,17; Boehm, Leanne M., PhD, RN, ACNS-BC18,19,20; Brown, Sheryl, BSN, RN, CCRN21; Clay, Alison S., MD22; Firshman, Penelope, BSc10; Greenberg, Steven, MD, FCCP, FCCM23; Harris, Wendy, RGN12; Hill, Christopher, M.Div, BCC7; Hodgson, Carol, PhD, FACP, BAppSc(PT), Mphil9,24; Holdsworth, Clare, BPhys (Hons)8; Hope, Aluko A., MD25; Hopkins, Ramona O., PhD3,16,26; Howell, David C. J., PhD, FFICM, FRCP27; Janssen, Anna, PhD, DClinPsy, CPsychol11; Jackson, James C., PsyD15; Johnson, Annie, APRN, ACNP-BC, CCRN28; Kross, Erin K., MD29,30; Lamas, Daniela, MD31; MacLeod-Smith, Belinda8; Mandel, Ruth, LCSW32; Marshall, John, PharmD, BCPS, BCCCP, FCCM33; Mikkelsen, Mark E., MD, MSCE34; Nackino, Megan, RN, BSN35; Quasim, Tara, MD, MPH, MBChB1,2; Sevin, Carla M., MD36; Slack, Andrew, MBBS, MRCP, EDIC, MD10; Spurr, Rachel, BSc, RGN10; Still, Mary, APRN, ACNS, ANP-BS, CCRN, FCCM37; Thompson, Carol, PhD, DNP, ACNP38; Weinhouse, Gerald, MD31; Wilcox, M. Elizabeth, MD, MPH39; Iwashyna, Theodore J., MD, PhD40,41

doi: 10.1097/CCM.0000000000003497
Online Clinical Investigations

Objectives: Patients and caregivers can experience a range of physical, psychologic, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism.

Design: We sought to identify technical, safety, and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation.

Subjects and Setting: Seventeen Thrive sites from the United States, United Kingdom, and Australia were represented by a range of healthcare professionals.

Measurements and Main Results: Via an iterative process of in-person and email/conference calls, members of the Collaborative defined the key areas on which peer support models could be defined and compared, collected detailed self-reports from all sites, reviewed the information, and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented. Within the Thrive Collaborative, six general models of peer support were identified: community based, psychologist-led outpatient, models-based within ICU follow-up clinics, online, groups based within ICU, and peer mentor models. The most common barriers to implementation were recruitment to groups, personnel input and training, sustainability and funding, risk management, and measuring success.

Conclusions: A number of different models of peer support are currently being developed to help patients and families recover and grow in the postcritical care setting.

1NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.

2University of Glasgow, Glasgow, United Kingdom.

3Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT.

4Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, UT.

5Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT.

6Dell Children’s Medical Centre, Austin, TX.

7VA Tennessee Valley Healthcare System, Nashville, TN.

8Western Health, Melbourne, VIC, Australia.

9Australia and New Zealand Intensive Care Society Research Centre, Monash University, Melbourne, VIC, Australia.

10Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.

11Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom.

12University College London Hospitals NHS Foundation Trust, London, United Kingdom.

13Society of Critical Care Medicine, Chicago, IL.

14Pulmonary, Critical Care, Allergy & Immunologic Diseases, Wake Forest School of Medicine, Winston Salem, NC.

15Vanderbilt University Medical Center, Nashville, TN.

16Intermountain Medical Center, Division of Pulmonary and Critical Care, Murray, UT.

17Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, UT.

18Vanderbilt University School of Nursing, Nashville, TN.

19VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, TN.

20Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN.

21NorthShore University HealthSystem, Chicago, IL.

22Duke University School of Medicine, Durham, NC.

23Evanston Hospital, NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Chicago, IL.

24Alfred Health, Melbourne, VIC, Australia.

25Jay B Langer Critical Care System, New York, NY.

26Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT.

27Critical Care Unit, University College London NHS Foundation Trust, London, United Kingdom.

28Mayo Clinic, Rochester, MN.

29Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.

30Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA.

31Division of Pulmonary and Critical Care Medicine, Brigham & Women’s Hospital, Boston, MA.

32NorthShore University Health System - Evanston Hospital, Chicago, IL.

33Beth Israel Deaconess Medical Center, Boston, MA.

34Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA.

35University Hospitals Cleveland Medical Center, Cleveland, OH.

36Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

37Emory University Hospital (Emory Healthcare), Atlanta, GA.

38College of Nursing, University of Kentucky, Lexington, KY.

39Division of Respirology, Department of Medicine, Toronto Western Hospital, Toronto, ON, Canada.

40Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI.

41Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.

*See also p. 146.

This work does not necessarily represent the views of the U.S. Government or the Department of Veterans Affairs.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Supported, in part, by grants from the Society of Critical Care Medicine.

Drs. McPeake’s, Drumright’s, Hough’s, Meyer’s, Wade’s, Bakhru’s, Barwise’s, Boehm’s, Brown’s, Greenberg’s, Hill’s, Johnson’s, and Quasim’s institutions received funding from the Society of Critical Care Medicine (SCCM). Dr. McPeake was funded by a Fellowship from the Scottish Government. Dr. Bakhru received support for article research from SCCM. Dr. Greenberg received funding from APSF (Editor-in-Chief) and Casmed (consultant). Dr. Hill disclosed government work (Veteran Affairs employee). Dr. Hope received support for article research from the National Institutes of Health. Dr. Howell received funding from Roche. Drs. McPeake’s and Quasim’s institutions also received funding from the Health Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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