N Engl J Med. 2007 Feb 1;356(5):469-78.
Erratum in:
N Engl J Med. 2007 Jul 12;357(2):203.
Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D,
Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R,
Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G,
Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B,
Azoulay E.
Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hôpitaux de
Paris, France.
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.) 2007 Massachusetts Medical Society