title: A communication strategy and brochure for relatives of patients dying in the ICU.
abstract: BACKGROUND
  There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement.
  
  
  METHODS
  Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference. Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress).
  
  
  RESULTS
  Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs. 20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs. 5 minutes [interquartile range, 5 to 10]). On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs. 39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs. 69%, P=0.01). The median HADS score was also lower in the intervention group (11, vs. 17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs. 67%; P=0.02; depression, 29% vs. 56%; P=0.003).
  
  
  CONCLUSIONS
  Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement. (ClinicalTrials.gov number, NCT00331877.)
authors.affiliation: Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lautrette
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.forename: Luc Marie
authors.initials: LM
authors.lastname: Joly
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Didier
authors.initials: D
authors.lastname: Barnoud
authors.forename: Gérard
authors.initials: G
authors.lastname: Bleichner
authors.forename: Cédric
authors.initials: C
authors.lastname: Bruel
authors.forename: Gérald
authors.initials: G
authors.lastname: Choukroun
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Fabienne
authors.initials: F
authors.lastname: Fieux
authors.forename: Richard
authors.initials: R
authors.lastname: Galliot
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Hugues
authors.initials: H
authors.lastname: Georges
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.forename: Mercé
authors.initials: M
authors.lastname: Jourdain
authors.forename: Georges
authors.initials: G
authors.lastname: Loubert
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
authors.forename: Fayçal
authors.initials: F
authors.lastname: Saidi
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: François
authors.initials: F
authors.lastname: Vincent
authors.forename: Nancy Kentish
authors.initials: NK
authors.lastname: Barnes
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pochard
authors.forename: Benoit
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology; D001601:Bereavement; D003142:Communication; D003863:Depression / Q000453:epidemiology; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D011368:Professional-Family Relations; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000517:prevention & control*; D019452:Terminally Ill / Q000523:psychology; D014789:Visitors to Patients / Q000523:psychology