Intensive care unit diaries-harmful or harmless: A systematic literature review and qualitative data synthesis.

Matthias Thomas Exl and Lea Lotzer joint first authorship.
Marie-Madlen Jeitziner and Peter Nydahl joint last authorship.

Objective
The objective of this research was to evaluate the extent of harm for critically ill patients, family members, and healthcare professionals associated with writing and reading intensive care unit (ICU) diaries.
Review Method Used
A systematic literature review and a synthesis of qualitative data were performed. The protocol of this study has been registered in the International prospective register of systematic reviews (CRD42022376393).
Data Sources
Databases were PubMed, Cochrane Library, CINAHL, PsychNet, and Livivo.
Review Methods
The search included qualitative and mixed-methods studies related to harm with an ICU diary. Deductive content analysis was used to create abstractions of quotations. Study quality was assessed with the Critical Appraisal Skills Programme.
Results
Of 12 827 titles, 27 studies with 476 participants were included. Events involving the patients, family members, and healthcare professionals occurred but did not result in harm. A total of 68 quotations from patients, family members, and healthcare professionals were extracted. Those patients, their families, and healthcare professionals who mentioned intense emotions regarding diaries experienced writing and reading diaries as an emotional journey (patients), a help with tears (families), or a question of emotional distance (healthcare professionals).
Conclusions
Writing and reading ICU diaries can be associated with intense emotions, which are natural reactions when coping with a stressful situation. No study reported harm. Based on uncertain qualitative evidence, the benefits of writing and reading ICU diaries as coping strategies outweigh the potential harm. More research is needed.
Registration Of Review
The International prospective register of systematic reviews CRD42022376393.