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Previous Volume 356:469-478 February 1, 2007 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Supplementary Material Editorial by Lilly, C. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article PubMed Citation

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 [ClinicalTrials.gov] .)

Source Information

From the Saint-Louis Hospital and Paris 7 University, Assistance Publique — Hôpitaux de Paris (A.L., M.D., S.C., F.F., N.K.B., F.P., B.S., E.A.), Lariboisière Hospital (B.M.), Bichat-Claude Bernard Hospital (C.B.), and Cochin Hospital and Paris 5 René Descartes University (G.C.) — all in Paris; Rouen University Hospital, Rouen (L.M.J.), Saint-Denis Hospital, Saint-Denis (C.A.), University Hospital, Grenoble (D.B.), Argenteuil Hospital, Argenteuil (G.B.), Pontoise Hospital, Pontoise (R.G.), Saint-Joseph Hospital, Saint-Joseph (M.G.-O.); Tourcoing Hospital, Tourcoing (H.G.), Gonesse Hospital, Gonesse (D.G.-T.), Salengro Hospital, Lille (M.J.), Raymond Poincaré Hospital, University of Versailles, Versailles (G.L.), La Roche sur Yon Hospital, La Roche sur Yon (J.R.), Nemours Hospital, Nemours (F.S.), Clermont-Ferrand Hospital, Clermont-Ferrand (B.S.), and Avicenne Hospital, Avicenne (F.V.) — all in France; and the School of Medicine, University of Washington, Seattle (J.R.C.).

Address reprint requests to Dr. Azoulay at Service de Réanimation Médicale, Hôpital Saint-Louis, 1 Ave. Claude Vellefaux, 75010 Paris, France, or at elie.azoulay{at}sls.aphp.fr.

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