The creation of patient diaries as a therapeutic intervention - for whom? (Editorial)

Abstract

There is now widespread evidence of the potential adverse psychological impact of critical illness (Parker et al., 2015; Nikayin et al., 2016; Rabiee et al., 2016). While many patients will show great resilience, others may develop post-traumatic stress disorder (PTSD) that endures for several years (Bryant et al., 2015) or anxiety or depressive symptoms, often comorbidly (Parker et al., 2015; Nikayin et al., 2016; Rabiee et al., 2016). One intervention that is thought to reduce these negative psychological outcomes is the use of patient diaries. These tend to be completed by nurses and, on many occasions, relatives. Their putative use is to fill any ‘memory gaps’ and provide a ‘sense of coherence’ for patients after critical care (Engstrom et al., 2009). However, for the relative, a diary may function more as a ‘journal’ that includes information not just about the patient and the patient's experience but also the relatives' feelings, hopes and emotions. There are a number of important issues to be considered in relation to the use of diaries (Aitken et al., 2013), five of which will be discussed in this editorial: the wish to help, early interventions, journals for relatives, whether journals for relatives are separate to diaries for patients and reframing interventions to include the relatives.