The Experiences of Family Members of Patients Discharged from Intensive Care Unit: A Systematic Review of Qualitative Studies
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
I consider it to be a work that will allow us to deepen the phenomenon of study on the support to caregivers and patients in the phase of discharge to their homes, the impact and contribution that the nursing profession can give from its metaparadigms such as care, the family, the individual. It is essential, I am sure that there is gray literature on the matter or databases such as scielo that could improve the depth in other contexts, but the databases chosen represent the nursing profession very well.
Author Response
Thank you for your review.
We agree that this review can enhance the understanding of nursing's impact on discharge support.
The chosen databases effectively represent the profession.
Reviewer 2 Report
Comments and Suggestions for Authors
Dear Authors,
Reading this paper, it can be appreciated your effort and accurate research. Being a systematic review of qualitative research adds consistency to the results reviewed, as well as emphasizing the different personal experiences. The aim of the review is to explore the experiences of family members of patients discharged from Intensive Care Units. Overall, the research aim, design and methodology are strong, using a well-structured analysis and review of the reference, using critical appraisal tools and assessing the bias of the studies included in the systematic revision. The conclusions are matched with the aim and the findings included in the studies reviewed. Finally, the implications for practice might contribute valuable insights, especially highlighting the need for a more family centred approach during the ICU discharge, recommendations that are in line with WHO patient centred care policies.
However, there is an aspect of the manuscript that it would be recommended to address, which is detailed as follows:
Minor Comments:
One suggestion for improvement might be introducing some extra considerations to the limitations section (line 372): Even though the gender variable is not collected in the studies included, biological sex and relationship degree is. With these variables, it would be recommended to discuss the implications of gender bias interpreting the results obtained in some of the studies. For example, in some studies included, the majority of participants were females and with a wife role.
Yours Sincerely,
Author Response
Dear Reviewer, thank you for your review and kind words provided.
Certainly, acknowledging the limitations of the gender variable omission and incorporating reflections on potential gender bias enriches the discussion.
We have also added a reference to support our statements.
Thank you for your suggestion
Reviewer 3 Report
Comments and Suggestions for Authors
Dear Authors
Thank you for the opportunity to review this manuscript. It is indeed an important and overlooked topic in the field of intensive care and I commend you on the work you have produced. There are few suggested changes to improve the quality of the manuscript.
Abstract
L10: change "comprehension" to "the understanding"
L15: change "through" to "of"
Keywords: family members, experience, perceptions, intensive care unit, discharge, qualitative
L31: change to "At the time of an emergency admission" or "During an emergency"
L32: change "therapeutic" to "care"
L40: the socioeconomic burden has also been considered in some literature on PICS-F. Consider adding this.
(Reference: , , , , , , et al. Postintensive care syndrome family: A comprehensive review. Acute Med Surg. 2024; 11:e939. https://doi.org/10.1002/ams2.939)
L54: reword "long term psychological outcomes/ psychological experiences of family members of ICU survivors"
L56: change "objective" to "aim"
L74: Were words like "spouse" or "partner" or "caregiver" included?
Figure 1 should appear below the figure.
Fig 1: Why are articles other than Italian included in the figure? This has not been stated in the text. What automation tools were used? This must be described in the methodology.
Table 3: The study by Czerwonka et al used the framework methodology. Please include this. A few other studies in this table do not have the methodology specified, but I could not find it in the original articles either. However, the type of analysis used should be included for these studies (thematic analysis, inductive etc.)
L252: change "sanitary system", this is not the correct work. ? Healthcare system,? homebased care system
L281 The abstraction theme "targeting care provision" doesn't really fit. The quotes and abstraction categories cover the holistic care that the patient needs rather than specific targets. Consider changing this to cover the holistic provision of care that the patient needs.
L332: ?caregivers ability to cope rather than caregiver performance
L356 remove (2012)
L372 No studies are included from LMICs (?none conducted in these countries) and this represents a gap in the research. Challenges faced here may be different based on the varies healthcare provision systems and social and cultural implications.
L385: change to "that a ICU patient home discharge"
Supplementary table
Please check the following two statements that are almost the same but from two different sources.
"I'm so busy, sometimes I think I can't keep going, I'm stuck..." (Nelderup et al)
"I'm so busy, sometimes I think I can't keep going, I'm stuck. Shall I tell him [the patient]. He probably has something else on his mind." (Van Sleeuwan et al)
The quote below should be moved to "feeling overwhelmed" rather than "feeling lost": "Then I was so scared to death that he was coming home..." (Nelderup eta al)
Correct: "Feeling frustrated"
The code "letting things go at their pace" is better included in the abstraction category "ability to cope with the demanding situation"
The following three quotes are better suited to the code "psychological needs"
1. "I want us to be like before. I hope we will>" (Vester et al)
2. "No matter how beautiful we live in this lovely, thatched farmhouse with a marvellous swimming pool, it is not worth it to me." (Nelderup et al)
"...thus you de end up neglecting your own feelings, what is bothering you is neglected. I have to put it away, and I have to deal with it little by little." (Frivold et al)
The code "setting the home environment is better suited to the abstraction category "activities performed as a caregiver". "Essential needs for caregiving" mainly focusses on the caregivers needs not the patient's needs.
References
Ref 8 & 12 seem to be missing a page range.
All the refernces do not have an issue, only a volume. Please correct this throughout the refernce list.
Comments on the Quality of English Language
The quality of the English is genrally good. Some minor edits have been detailed in the comments to the authors above.
Author Response
Dear reviewer, thank you for your thorough and insightful review; your feedback has been invaluable in enhancing the quality of our work.
We've made the changes suggested, and answered all the questions raised. The text has been improved.
Thank you for reviewing also the supplementary table and identifying the inconsistencies, which we have now amended.
Please find the text highlighted in yellow.
Reviewer 4 Report
Comments and Suggestions for Authors
Basso et al have tried to summarize results of eight qualitative studies on experiences from family members of discharged ICU patients in a systematic review. The subject is important, post-ICU patients are a heavy burden for society and for their family and loved ones especially if the latter are also caregivers at home. The manuscript is written clearly, but however, the authors in my opinion, did not succeed in categorizing the post-ICU problems of family members in such a way that this adds to our understanding of the problem or to the theoretical, conceptual or practical approach to the problem. The systematic review shows what the individual studies show: family members are burdened, helpless and in need of support, although their problems are diverse. This is important knowledge, but the systematic review does not add additional knowledge. This is most probably not the ‘fault’ of the authors, they have tried their best, but the problem of the methodology (systematic review of qualitative studies) and the subject itself.
Author Response
Thank you for your feedback. We appreciate your insights and acknowledge the limitations of our systematic review methodology in fully addressing the complexity of post-ICU family experiences.
We aimed to provide a comprehensive synthesis of existing qualitative studies but recognize the challenge in categorizing diverse post-ICU problems.
We have added this in the limitation section.
