Background: Among survivors of critical illness, post-traumatic stress disorder (PTSD) is common and reduces quality of life. In numerous clinical contexts, compassionate patient care improves psychological outcomes for patients. We tested the hypothesis that during a life-threatening medical emergency, patient perception of health care provider (HCP) compassion is associated with subsequent development of PTSD symptoms.
Methods: Prospective cohort study in the emergency department (ED) of an urban academic medical center. We included adult patients presenting with a life-threatening medical emergency, defined as respiratory or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. We measured patient perception of HCP compassion in the ED using the Consultation and Relational Empathy (CARE) Measure, a validated 45-point scale. Blinded to initial ED data (including the CARE Measure), we assessed PTSD symptoms one month post-discharge using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5). As recommended by the National Center for PTSD we defined clinically significant PTSD symptoms as a PCL-5 score of two or more on at least: 1 B item (questions 1-5), 1 C item (questions 6-7), 2 D items (questions 8-14), 2 E items (questions 15-20), or a total score ≥ 33 points.
Results: Of the 88/100 (88%) patients who completed follow up, 26% (95%CI 17%-37%) had clinically significant PTSD symptoms at one month. In a multivariable model adjusting for potential confounders (e.g. severity of illness score in ED, need for intensive care unit admission, ED overcrowding, and family member emotional support in the ED), patient perception of higher HCP compassion in the ED was independently associated with lower clinically significant PTSD symptoms at one month, odds ratio 0.94 (95%CI 0.89-0.99). A one-point increase in the ED CARE Measure was associated with a 6% decrease in the odds of developing clinically significant PTSD symptoms.
Conclusions: Clinically significant PTSD symptoms are common among ED patients with life-threatening medical emergencies. Patient perception of higher HCP compassion during the emergency is independently associated with lower development of PTSD symptoms. Future research to test the impact of compassionate care interventions on emergency care related PTSD is warranted.