A communication strategy and brochure for relatives of patients dying in the ICU.
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.)
Lautrette
Alexandre
A
Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, France.
Darmon
Michael
M
Megarbane
Bruno
B
Joly
Luc Marie
LM
Chevret
Sylvie
S
Adrie
Christophe
C
Barnoud
Didier
D
Bleichner
Gérard
G
Bruel
Cédric
C
Choukroun
Gérald
G
Curtis
J Randall
JR
Fieux
Fabienne
F
Galliot
Richard
R
Garrouste-Orgeas
Maité
M
Georges
Hugues
H
Goldgran-Toledano
Dany
D
Jourdain
Mercé
M
Loubert
Georges
G
Reignier
Jean
J
Saidi
Fayçal
F
Souweine
Bertrand
B
Vincent
François
F
Barnes
Nancy Kentish
NK
Pochard
Frédéric
F
Schlemmer
Benoit
B
Azoulay
Elie
E
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