Results
traumatic, pains, aches, positively.“It
EVENTS, SECONDARY, SAID, EVENT
Table Patient characteristics (The following presentation of the results is based on the interview guideline (see e-supplement Four categories merged from our analysis of patient interviews:Long-term trustful relationship between patient and the GP teamMost patients cited a long-term and trustful relationship to the GP team as major facilitator for the success and acceptance of the intervention. Vice versa, lack of this relationship was identified as a possible barrier.Intervention by a medical doctorA medical doctor who applies the intervention has the sufficient knowledge about the ICU setting and knowledge of the patient’s medical history. This knowledge was perceived as great advantage in comparison to the more theoretical knowledge attributed to psychotherapists, who are not familiar to these settings. However, a single patient stated that a GP team might be not sufficiently trained to have these kind of psychological conversations and identified the missing qualification as barrier of acceptance.Professional emotional distance of the GP teamThe professional emotional distance of the GP team was perceived as relieving for patients and their families in terms of “professional complicity” and was a strong facilitator for acceptance of the intervention.Brevity of the interventionThe brevity of the intervention was mentioned as a barrier for acceptance by two patients. They would have liked more time for the intervention or more than the three sessions offered. Table Long-term trustful relationship between patient and the GP teamMost frequent cited facilitators and barriers for acceptance of the NET interventions identified by patientsFive patients cited the long-term trustful relationship between patient and the GP team as the main facilitator for the acceptance of the NET intervention. An interviewee emphasized the importance of home visits as well as the quick and low-threshold accessibility of the GPs practice:“I won´t hear a word against my doctor (laughs), she is simply the best. How long does it take to find a doctor that makes house calls? Besides that, she is always ready to listen. When I call the practice, then she calls me back within 10 min and that is really super.” (B8; female, 52 years old, secondary school, admission diagnosis: polytrauma)Other patients also report the very good and trusting relationship with their GP, which they describe as fundamental to the acceptance of the intervention."Very positive. (…) Because there is a certain level of trust with her, (…) because that is a prerequisite." (B3; female, 59 years old, high school diploma, admission diagnosis: cardiac surgery)“The doctor, simply put, knows me..…..inside out, she knows each of my little aches and pains….and that is naturally very helpful, because then I know for sure, that she wouldn´t do anything that is not good for me ….and that´s reassuring.”(B8; female, 52 years old, secondary school, admission diagnosis: polytrauma)This statement indicates that, from the patient's perspective, mental and physical health are inextricably linked. Good psychological support is therefore assumed, since the long-term doctor-patient relationship also means that the patients` medical history is known.The telephone contact with the medical assistant was rated neutrally by three respondents, one respondent explicitly emphasized this contact as positive. “I perceived this kind of psychological treatment and the questionnaires quite supportive and then also these calls from the receptionist, who asked me again and again: And, if you look back now, how did you feel in the last two weeks? I think it's good that you just reflect a bit and then maybe classify some things a little different for yourself. Or then maybe you realize why it could have been like that or why you could have reacted like that.” (B5; female, 52 years old, high school diploma, admission diagnosis: sepsis)Consequently, a female patient identified a primarily unknown GP as a possible barrier for the acceptance of the intervention. She was treated by a previously unknown GP colleague of her GPs practice.“I think it would be better if a psychotherapist did it, but I would also recommend it if a general practitioner did it. So I think talking about it is definitely better than not doing it at all.” (B5; female, 52 years old, high school diploma, admission diagnosis: sepsis)Intervention provided by a medical doctorFour interviewed patients assessed the medical background knowledge of their GP team positively.“It was just good to talk to someone about it and that they were by my side in my illness and that they understand you and how the pills work and how they can work. They were all cool, nice.” (B1; male, 59 years old, secondary schools, admission diagnosis: transplantation (liver or lung))“Because she also knows this background a bit, on the other hand, of course, had a medical idea and saw my medical course (…).” (B2; male, 66 years old, high school diploma, admission diagnosis: cardiac surgery)“From her medical point of view, because she's not a psychologist (…) she asks different questions and has a different approach and also this medical understanding, what psychologists, not all, but many do not have (…), […]. It happened on a (…) different level, […] I don't need to explain anything to a medical doctor." (B4; female, 47 years old, intermediate maturity, admission diagnosis: neurosurgical intervention)Vice versa, another patient resumed, that she would have preferred to get the intervention by a psychotherapist instead of a GP."I found […] that it (…) was somehow conducted strictly according to this given pattern.I: Was that too strict for you?R: (…) Yes, let's say: I felt it was more like ticking off and less like a […] face-to-face conversation, […] that now it feels to me like a list has been worked through and […] I could imagine that someone with an appropriate training would have approached it a little differently.” (B5; female, 52 years old, high school diploma, admission diagnosis: sepsis)Professional emotional distance of the GP teamTwo of the interviewees pronounced the professional distance of the GP team who applied the intervention as very beneficial: "That I can just talk without having to worry that whoever is sitting across from me is concerned about me, but still understands me." B4; female, 47 years old, intermediate maturity, admission diagnosis: neurosurgical intervention).“… telling that to someone else, someone who is not involved, that just feels good and sheds a little ballast. And when this person does not think that one is nuts, then it is just helpful.”(B8; female, 52 years old, secondary school, admission diagnosis: polytrauma)This kind of professional knowledge helps some of the interviewees, since they can relieve their families and relatives in particular."Well, I notice that my mother is afraid, and […] I try to avoid talking about it as much as possible (…). I don't want that either, I don't want her to be afraid about me, I don't want that (…). And (…) so, that was it with the PICTURE study, I thought it was good, because it's a situation where I could just get rid of things like that, I found it extremely helpful." (B4; female, 47 years old, intermediate maturity, admission diagnosis, admission diagnosis: neurosurgical intervention)Brevity of the interventionTwo patients expressed concerns due to the brevity of the intervention. They would have preferred to have more sessions than three.“I found that three sessions were a little, I do not want to say, a little short, but four or five would not have been bad. Sometimes I had the wish I may talk about this or that longer.” (B4; female, 47 years old, intermediate maturity, admission diagnosis, admission diagnosis: neurosurgical intervention)To sum up, we also asked for content-related objective and subjective descriptions of the intervention components. The participants evaluated the first session as profound, but at the same time easy to carry out and valuable to get familiar with this kind of narrative exposition:“ (…) in the first session she explained the basics, then came at some point kind of (…), how should I name it (…) almost like that family constellation (…), with positive and negative experiences, (…) starting from childhood (…) up to this moment in the intensive care unit.” (B3; female, 59 years old, high school diploma, admission diagnosis: cardiac surgery)“ (…) the first session with my life up to that point, (…) I think I'm relatively fine with that. (…) but I think I can somehow deal with it a bit and that's why it wasn't difficult” (B2; male, 66 years old, high school diploma, admission diagnosis: cardiac surgery)“I thought it was really nice, because I liked the idea with the stones and the flowers, (…) looking back, I thought the structure was totally cool and yes, (…) was just good for getting into the topic.” (B4; female, 47 years old, intermediate maturity, admission diagnosis, admission diagnosis: neurosurgical intervention)The two upcoming sessions were perceived as very helpful to talk about the feelings and impression referring to a traumatic event, like ICU-care.“ I: And in the other session: Do you remember what that was about?R: Yes, that was what used to be (…), an earlier event, among other things I remembered, with my father, as a negative event” (B3; female, 59 years old, high school diploma, admission diagnosis: cardiac surgery)”“To be honest, I can't remember the last one exactly, but the second one, we really did then talk about the event, when I woke up in the night, was tied up and kind of like that was completely helpless and couldn't communicate (...) and no one ever told me what it was like, everything went well or something like that.” (B5; female, 52 years old, high school diploma, admission diagnosis: sepsis)”“I think it was easier to talk about it, much easier than with the neuropsychologists. With her, talking about that helplessness specifically, I think that's what worries me the most is somehow done, it was much easier with her, with more distance to the events. So then there were no more tears, which, as I said, I certainly did with the neuropsychologists really had too much (…) because somehow I was a bit more distant from it.” (B4; female, 47 years old, intermediate maturity, admission diagnosis, admission diagnosis: neurosurgical intervention)