Patients often have high expectations for recovery after critical illness, but the impact of these expectations on their subsequent quality of life (QoL) after serious illnesses has not been empirically evaluated.
Among adult survivors of acute respiratory failure (ARF), are met vs unmet expectations for health associated with self-reported QoL 6 months after discharge?
Prospective longitudinal cohort study enrolling consecutive adult patients with ARF managed in ICUs at five academic medical centers. At hospital discharge, we evaluated participants’ expected health 6 months in the future via a visual analogue scale (VAS) (range: 0-100) with higher scores representing better expected health. At 6-month follow-up, perceived health was assessed using the EQ-5D VAS, and quality of life was assessed using the WHOQOL-BREF instrument. Participants’ health expectations were categorized as “met” when perceived health at six months was no more than eight points lower than their expectation at study enrollment. The primary analysis compared WHOQOL-BREF domain scores (range: 0-100) at 6 months after discharge, in patients with met versus unmet health expectations using the nonparametric Mann-Whitney U test. Secondary analysis modeled WHOQOL-BREF domain scores using multivariable regression, and sensitivity analyses assessed QoL using EQ-5D-5L index values.
In the primary analysis, QoL was significantly better among participants with met vs unmet health expectations across all domains of the WHOQOL-BREF: physical health (estimated difference in scores [IQR] = 19 [12-15], P<0.001), psychological health (12 [6-18], P<0.001), social relationships (6 [0-13], P=0.02), and environmental health (12 [6 – 13], P<0.001). In multivariable regression, the difference between expected and perceived health remained significantly associated with the physical health domain score.
Fulfillment of health expectations is associated with better QoL after ARF, suggesting a mechanism under-pinning successful ICU recovery programs that incorporate normalization and expectation management.

Copyright © 2023. Published by Elsevier Inc.