Core outcome set for research on critically ill obstetric patients (COSCO): Patient interviews

Objectives Critical illness during pregnancy is fortunately rare. The conduct of high-quality research in this area requires standardized outcomes important to all involved stakeholders. We therefore performed interviews with women who were critically ill during pregnancy to identify patient-important outcomes for the development of the core outcome set for research on critically ill obstetric patients (COSCO). Methods Women were identified by reviewing previous intensive care unit (ICU) admissions in the participating centers in Toronto, Canada and Cartagena, Colombia. Individual interviews using a predefined script were led by local researchers to identify outcomes important to the interviewees. Discussions were recorded, transcribed and translated into English, where necessary. The transcripts underwent inductive thematic analysis by a qualitative analyst to delineate themes and patient-important outcomes. These outcomes were coded into domains using a recently published taxonomy. Results Twelve women were interviewed. Main themes included the intensive care unit experience, communication of the diagnosis, independence, relationship with healthcare workers and patient privacy. Many women experienced a negative experience with feelings of fear, pain and separation from their newborn. Physical independence and role functioning as a mother during and after their ICU stay were highly important. These themes were coded into four outcome domains : physiological (pain), pregnancy-related (mother-newborn separation), life impact (physical functioning, role functioning, fear, isolation) and delivery of care (communication, satisfaction, privacy). Conclusions We identified patient-important outcomes which should be part of further prospective research on maternal critical illness. The results of these interviews are an essential step towards development of COSCO.