Fatigue after CriTical illness (FACT): Co-production of a self-management intervention to support people w/fatigue after critical illness 2024 Brown+

[Andy]

Abstract

Purpose
Fatigue is a common and debilitating problem in patients recovering from critical illness. To address a lack of evidence-based interventions for people with fatigue after critical illness, we co-produced a self-management intervention based on self-regulation theory. This article reports the development and initial user testing of the co-produced intervention.

Methods
We conducted three workshops with people experiencing fatigue after critical illness, family members, and healthcare professionals to develop a first draft of the FACT intervention, designed in web and electronic document formats. User testing and interviews were conducted with four people with fatigue after critical illness. Modifications were made based on the findings.

Results
Participants found FACT acceptable and easy to use, and the content provided useful strategies to manage fatigue. The final draft intervention includes four key topics: (1) about fatigue which discusses the common characteristics of fatigue after critical illness; (2) managing your energy with the 5 Ps (priorities, pacing, planning, permission, position); (3) strategies for everyday life (covering physical activity; home life; leisure and relationships; work, study, and finances; thoughts and feelings; sleep and eating); and (4) goal setting and making plans. All material is presented as written text, videos, and supplementary infographics. FACT includes calls with a facilitator but can also be used independently.

Conclusions
FACT is a theory driven intervention co-produced by patient, carer and clinical stakeholders and is based on contemporary available evidence. Its development illustrates the benefits of stakeholder involvement to ensure interventions are informed by user needs. Further testing is needed to establish the feasibility and acceptability of FACT.

Implications for clinical practice
The FACT intervention shows promise as a self-management tool for people with fatigue after critical illness. It has the potential to provide education and strategies to patients at the point of discharge and follow-up.

Open access, https://www.sciencedirect.com/science/article/pii/S0964339724000399

 

[Andy]

"Self-regulation theory is a valuable foundation for self-management, which aims to equip patients with the tools they need to effectively cope with an ongoing condition or the aftermath of a healthcare event (Taylor et al., 2014). We therefore sought to provide a ‘scaffold’ for people with fatigue after critical illness to carry out self-regulation by equipping them with sufficient information to create their own set of effective management strategies and making the process of formulating and pursuing goals explicit and guided. In accordance with the aim of self-management, the goal of the intervention developed was to support people to manage and cope with their fatigue leading to an improved HRQoL, rather than to reduce the level of fatigue."

 

[Sean]

Self-regulation theory is a valuable foundation for self-management, which aims to equip patients with the tools they need to effectively cope with an ongoing condition or the aftermath of a healthcare event (Taylor et al., 2014). We therefore sought to provide a ‘scaffold’ for people with fatigue after critical illness to carry out self-regulation by equipping them with sufficient information to create their own set of effective management strategies and making the process of formulating and pursuing goals explicit and guided.​

What a bunch of infantilising insulting drivel.

 

[rvallee]

To address a lack of evidence-based interventions for people with fatigue after critical illness, we co-produced a self-management intervention based on self-regulation theory

So starting from the premise that there are no evidence-based interventions for this, they... more or less copy-paste the current model of generic 'evidence-based' recommendations that they pretend are 'bespoke' because they're so generic that everyone takes different things from it.

They've always been at war with East Asia. And they've always counted on the help of East Asia in their protracted struggle with West Asia. They're even going full Orwellian here by using the FACT acronym for this dud pseudoscience, which is entirely free of facts in any way shape or form.

They start with the premise that there are no evidence-based interventions, certainly true, then assert that their novel thing is good because it's based on contemporary evidence.

Incredible. As in literally it's not credible that this bullshit is happening.

Words and their meaning, so complicated:

Development of the FACT intervention was guided by Leventhal et al.’s self-regulation theory, which proposes that patients choose how they manage illness based on their own understanding of the illness experience

This is not a theory anymore than the vague promises on some BS health supplement that will 'boost health' and 'optimize' this and that amounts to a theory. At best, and this is a stretch, this is a use of theory in the same sense as the common misuse, which generally means a hunch/guess/gut feeling.

The Goal setting and Action Planning (G-AP) framework was used to provide a structured process for setting and pursuing goals with support from a facilitator. G-AP is a theory and evidence-based framework

Also it's both pragmatic and theory-based. This is theory-based in the same sense as Scientology and homeopathy are. Whatever, words have zero value in this ideology.

 

[Ravn]

Have only skimmed this but it actually looks pretty good to me.

Yes, it's theory-driven but the theory is that patients are in charge and the role of health professionals is to assist them with whatever support the patients decide they need.

It looks like a genuine co-production and I think it shows, e.g. in their sensible discussion around the terms of 'tiredness' (do not use) and 'goal setting' (strictly limited application only)

The tool is intended for use in post-ICU situations, not ME, so at least some people can reasonably expect rehabilitation to be of some use.

Even in that context the main aim of the tool is QoL, with any actual reduction in fatigue being a bonus.

There's talk about goal setting but goals here includes things like becoming better at utilising available support to better manage fatigue.

Goal setting was generally seen as an useful element to include, but patients particularly emphasised the need for sensitivity around the language of goal setting and allowing users to choose if and when to utilise it

There's a lot of emphasis on the ‘5 Ps’ (priorities, pacing, planning, permission, position) and on accessing support for patients - who are new to the whole business of coping with the post-ICU life so stuff that seems obvious to us veterans may not seem obvious at all to them.

My main criticism of the paper is that after developing it - that bit looked quite rigorous - they only tested it on 4 people, and only for a short time.

Apart from that it looks like it could be more useful even for newly diagnosed pwME than a lot of the actual ME stuff out there

 

[TiredSam]

That is not how acronyms work.

 

[TiredSam]

Might I suggest an improvement:

Fatigue After Critical ILlnEss (FACILE)

 

[SNT Gatchaman]

At least they used the "a" in "after" and not the "u" in "fatigue".

 

[Jonathan Edwards]

Yes, it's theory-driven but the theory is that patients are in charge and the role of health professionals is to assist them with whatever support the patients decide they need.

~We had that in the 1980s. She was called an occupational therapist.
`Why does an OT have to become a FACT?

We don't want any sort of theory. We want practical advice based on evidence. Not much evidence of evidence here. Useful bits of evidence are things like if you get handrails fitted the person can get out of the bath.