Table 1

Summary of key components of process evaluation highlighted by each study conducted by the authors

Qualitative study of critical illness survivors 200912 Telephone CST 20129 Telephone mindfulness training RCT 20148 Telephone and web-based CST vs education control RCT 20187 Mobile mindfulness vs telephone mindfulness vs education control RCT 20185
 ‘What’N/ACSTMindfulness trainingCST vs education controlMindfulness training vs education control
 ‘How’Telephone delivery: acceptable and feasibleTelephone delivery: acceptable and feasibleTelephone and web-basedTelephone vs mobile App
 Dose6 weekly sessions6 weekly sessions6 weekly sessions4 weekly sessions
 InterventionistCritical care nurseClinical psychologist and MDClinical psychologistClinical psychologist
Not describedNot describedNot describedAudio recording (telephone) and technology-based tracking (App)
7/10 enrolled patients completed all study procedures 7/7 starting intervention completed it6/11 patients enrolled completed all study procedures62/86 (72%) and 69/89 (78%) patients randomised to CST and education control, respectively, completed all study procedures22/31 (71%), 28/31 (90%) & 16/18 (89%) randomised to mobile mindfulness, telephone mindfulness and education control completed all study procedures, respectively
92% (77/84) possible sessions completedProportion of sessions completed not reported54/86 (63%) and 58/89 (65%) of CST and education control patients, respectively, completed ≥1 session93/96 (97%) possible weekly app sessions were completed
Most common reason for low adherence was ‘medical illness’. Loss to follow-up associated with low education and family support; greater financial stress & baseline psychological distress; discharge to inpatient rehabilitation or skilled nursing facilitySelf-paced might have improved adherence to App
 OtherAble to incorporate caregiversOpportunity to improve access to intervention (perhaps using technology)Patients requested more interactive features and enhanced visualisation of progress over time
Mechanisms of impactN/AUnclear if there is a differential response based on baseline symptoms and coping skillsIncreases in mindfulness qualities were associated with improvements in psychological distressGreater improvement in self-efficacy among those with higher baseline HADS scoresIncreased frequency, duration and quality of App use associated with greater decrease in depression symptoms
ContextICU survivors commonly experience psychological distress
Few evidence-based interventions to improve psychological distress in ICU survivors
Ineffective coping is associated with increased psychological stressMindfulness training, a behavioural intervention, is beneficial in improving psychological distress in other populationsWeb-based content might enhance the effects of telephone-delivered CST
Patients with high baseline distress might be the most likely to benefit
There are potential barriers to delivering an intervention by phone. A mobile App might overcome such barriers
  • App, application; CST, coping skills training; HADS, Hospital Anxiety and Depression Scale; ICU, intensive care unit; MD, doctor of medicine; N/A, not applicable; RCT, randomised controlled trial.