A Communication Strategy and Brochure for Relatives of Patients Dying in the ICU

Alexandre Lautrette, Michael Darmon, Bruno Megarbane, Luc Marie Joly, Sylvie Chevret, Christophe Adrie, Didier Barnoud, Gérard Bleichner, Cédric Bruel, Gérald Choukroun, J. Randall Curtis, Fabienne Fieux, Richard Galliot,Maité Garrouste-Orgeas, Hugues Georges, Dany Goldgran-Toledano, Mercé Jourdain, Georges Loubert, Jean Reignier, Fayçal Saidi, Bertrand Souweine, François Vincent, Nancy Kentish Barnes, Frédéric Pochard, Benoit Schlemmer, and Elie Azoulay

N Engl J Med 2007;356:469-78

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.

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