Discussion
PTSS, cardiac fear and cardiac avoidance, Cardiac Anxiety, cardiac fear
RECRUITMENT
The FAID Fear pilot RCT demonstrated the feasibility of conducting a larger RCT evaluating a theory-based and mechanism-focused family-authored ICU diary intervention to reduce distress in patients experiencing CA. Primary outcomes demonstrated excellent recruitment and retention rates, ascertainment of primary outcomes, and adherence to the diary intervention. Participant reports of feasibility, acceptability, and appropriateness of the diary intervention for reducing fear about their loved one’s heart were also promising.Given such promising initial indicators of feasibility, the FAID Fear intervention is well-suited to being scaled up and implemented in a larger study powered to test mechanism engagement (i.e., cardiac fear, PTSS). For example, in the study by Nielsen et al., on which our protocol was based [In general, family members in the diary intervention agreed that the diary was appropriate, feasible, and acceptable. Even though participants were instructed to write as often as they want, “preferably at least twice a week,” most met this self-reported minimum, and many wrote even more than suggested. Some shared that they found the diary so beneficial that they continued their use of the diary even after the intervention period ended. Some participants also experienced a delay in receiving the diary after completing the baseline session, affecting intervention engagement. Because these recommendations were not an explicit rule, it may be that strengthening this language would result in even greater adherence to the diary intervention. Future studies should also consider the optimal frequency of writing in the ICU diary.Due to its mechanistic focus on the potential social transmission of distress from family members to patients experiencing CA, it is worth noting that cardiac fear was lower for participants in the diary intervention (v. the control group) at the end of hospital care, and both cardiac fear and cardiac avoidance were lower for participants in the diary intervention (v. the control group) at 30 days after the end of hospital care. Although underpowered, this provides preliminary evidence that cardiac fear and cardiac avoidance in family members may serve as a proximal target mechanism for improving patient outcomes (or, at minimum, provides no indication to the contrary). Indeed, increased attention has been drawn to the essential role of close others in determining health outcomes and the promise of socially-based interventions to improve health and well-being [FAID Fear is unique among ICU diary interventions in that the diaries are intended for family members and not for survivors. It was not known whether this intervention would be feasible in a population that often focuses solely on the health and well-being of their loved one, who has experienced a CA, at the expense of their own needs [Study successes must be considered in light of several limitations. First and foremost, given the primacy of romantic relationships for shaping health and well-being [The Cardiac Anxiety Questionnaire (CAQ) is validated for use when asking about a person’s own health [