Patients’ perspectives of recovery after COVID-19 critical illness; an interview study

Background Critical illness is a traumatic experience, often resulting in post intensive care syndrome, affecting people’s physical, psychological, emotional, and social well-being. The early recovery period is associated with increased risk, negatively impacting longer-term outcomes. Aims The aims of this study were to understand the recovery and rehabilitation needs of people who survive a COVID-19 critical illness. Objectives were to: • Describe survivors’ experiences of COVID-19 critical illness • Identify survivors' perspectives on the support required to optimise rehabilitation and recovery • Determine the extent to which findings align with those of other critical illnesses survivors. Design and Methods An exploratory descriptive qualitative interview study with 20 survivors of COVID-19 critical illness from two community-based healthcare settings in London, England. Data collection took place September 2020-April 2021, at least one month after hospital discharge by telephone or virtual platform. Data were subjected to a standard process of thematic analysis and mapped to the three core concepts of self-determination theory: autonomy, competence and relatedness. Findings Three key themes emerged: traumatic experience, human connection and navigating a complex system. Participants described how societal restrictions, fear and communication problems caused by the pandemic added to their trauma and the challenge of recovery. The importance of positive human connections, timely information and support to navigate the system was emphasised. Conclusions Whilst findings to some extent mirror those of other qualitative pre-pandemic studies, our findings highlight how the uncertainty and instability caused by the pandemic adds to the challenge of recovery affecting all core concepts of self-determination (autonomy, competence, relatedness). Relevance to clinical practice Understanding survivors’ perspectives of rehabilitation needs following COVID-19 critical illness is vital to delivery safe, high-quality care. To optimise chances of effective recovery, survivors desire a specialist, co-ordinated and personalised recovery pathway, which reflects humanised care. This should be considered when planning future service provision.