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Crit Care Med. 2018 Sep;46(9):1522-1531. doi: 10.1097/CCM.0000000000003293.

Peer Support in Critical Care: A Systematic Review.

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Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Melbourne, VIC, Australia.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Division of Pulmonary and Critical Care, Department of Medicine, Intermountain Medical Center, Murray, UT.
Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.
Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT.
Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom.
School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom.
Library Service, Western Health, Melbourne, VIC, Australia.
Division of Pulmonary & Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI.
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.



Identifying solutions to improve recovery after critical illness is a pressing problem. We systematically evaluated studies of peer support as a potential intervention to improve recovery in critical care populations and synthesized elements important to peer support model design.


A systematic search of Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Excertpa Medica Database was undertaken May 2017. Prospective Register of Systematic Reviews identification number: CRD42017070174.


Two independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were included where 1) patients and families had experienced critical illness and 2) patients and families had participated in a peer support intervention. Discrepancies were resolved by consensus and a third independent reviewer adjudicated as necessary.


Two independent reviewers assessed study quality with the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines and interventions summarized using the Template for Intervention Description and Replication Checklist.


Two-thousand nine-hundred thirty-two studies were screened. Eight were included, comprising 192 family members and 92 patients including adults (with cardiac surgery, acute myocardial infarction, trauma), pediatrics, and neonates. The most common peer support model of the eight studies was an in-person, facilitated group for families that occurred during the patients' ICU admission. Peer support reduced psychologic morbidity and improved social support and self-efficacy in two studies; in both cases, peer support was via an individual peer-to-peer model. In the remaining studies, it was difficult to determine the outcomes of peer support as the reporting and quality of studies was low.


Peer support appeared to reduce psychologic morbidity and increase social support. The evidence for peer support in critically ill populations is limited. There is a need for well-designed and rigorously reported research into this complex intervention.

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