“I wish I had better news”: Psychological distress, risk factors and professional physician-patient communication in hospitalized patients and their relatives

Introduction: Falling ill and being hospitalized is a significant experience in any person’s life, which oftentimes not only entails physical, but also psychological sequelae. This thesis aims at studying psychological distress, risk factors, and professional physician-patient communication in patients with high prognostic uncertainty and high risk for mortality.
Methods: Several methodological approaches were used: two prospective observational cohort studies to assess psychological distress and long-term health impairments, as well as risk and protective factors in COVID-19 patients and relatives and out-of-hospital cardiac arrest patients; a systematic review and meta-analysis to assess medical futility for CPR on IHCA patients’ definitions, measures and association with do-not-resuscitate code status and evaluation of predictive values of clinical risk scores; a narrative review to assess the effect of stress on CPR performance in resuscitators; and a randomized controlled trial to evaluate an E-learning tool’s aid in enhancing communication techniques in breaking bad news.
Results: In both studies on psychological distress after COVID-19 infection, patients and relatives are similarly affected by psychological sequelae at 1- and 3-month follow-up with prevalences of psychological distress, anxiety, depression, and PTSD symptoms ranging between 18.3%-22.9%, 14.2%-17.5%, 7.9%-15%, and 2%-8.7%, respectively. Several sociodemographic, psychosocial, and hospital-related factors were associated with psychological distress at one and three months after hospitalization, with risk factors such as perceived stress and overall burden, social connectedness, and resilience recurring over both time points in patients and relatives.
Concerning findings on cardiac arrest, we found that 50% of OHCA survivors suffered from long-term impairments including 37% in the physical domain, 25% in the cognitive domain and 13% in the psychological domain, with similar prevalences at 12-month follow up. Further, several partially modifiable risk factors were identified. When aiming to identify patients in which CPR may be deemed futile, several pre-arrest risk scores were identified with good prognostic value for poor neurologic outcome/in-hospital mortality in the meta-analysis (6 studies, 115213 participants with GO-FAR and PIHCA score; RR 6.93 [95% CI 6.43-7.47]). Further, in the narrative review we found that resuscitators’ stress levels are associated with resuscitation performance and identified only few interventional studies that aim to reduce this effect.
Last, we found that an E-learning assignment could improve medical students’ accurate recognition of communication techniques for breaking bad news concerning inappropriate communication elements (2.33 [2.57] versus 3.33 [3.39], p = 0.037).
Discussion: Illness and hospitalization do not only entail physical impairment, but also psychological distress in a relevant proportion of critically ill patients long after hospital discharge. However, during hospitalization several risk factors can be considered, which can help preventatively target at-risk patients or modify treatment for these patient groups. Further, appropriate communication of bad news and risk communication is of vital importance and can be improved through targeted communication strategies and clearly defined risk factors to be able to reduce potential uncertainty and distress during medical treatment.