A communication strategy and brochure for relatives of patients dying in the ICU.

@article{citeulike:2447195, 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.)}, address = {Saint-Louis Hospital and Paris 7 University, Assistance Publique-H\^{o}pitaux de Paris, France.}, author = {Lautrette, A. and Darmon, M. and Megarbane, B. and Joly, L. M. and Chevret, S. and Adrie, C. and Barnoud, D. and Bleichner, G. and Bruel, C. and Choukroun, G. and Curtis, J. R. and Fieux, F. and Galliot, R. and Garrouste-Orgeas, M. and Georges, H. and Goldgran-Toledano, D. and Jourdain, M. and Loubert, G. and Reignier, J. and Saidi, F. and Souweine, B. and Vincent, F. and Barnes, N. K. and Pochard, F. and Schlemmer, B. and Azoulay, E. }, citeulike-article-id = {2447195}, doi = {http://dx.doi.org/10.1056/NEJMoa063446}, issn = {1533-4406}, journal = {N Engl J Med}, keywords = {ami, ethic}, month = {February}, number = {5}, pages = {469--478}, posted-at = {2008-02-29 10:14:17}, priority = {0}, title = {A communication strategy and brochure for relatives of patients dying in the ICU.}, url = {http://dx.doi.org/10.1056/NEJMoa063446}, volume = {356}, year = {2007} }

TY - JOUR ID - citeulike:2447195 L3 - citeulike-article-id:2447195 TI - A communication strategy and brochure for relatives of patients dying in the ICU. JF - N Engl J Med VL - 356 IS - 5 SP - 469 EP - 478 AD - Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, France. SN - 1533-4406 N2 - 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.) KW - ami KW - ethic AU - Lautrette, A AU - Darmon, M AU - Megarbane, B AU - Joly, LM AU - Chevret, S AU - Adrie, C AU - Barnoud, D AU - Bleichner, G AU - Bruel, C AU - Choukroun, G AU - Curtis, JR AU - Fieux, F AU - Galliot, R AU - Garrouste-Orgeas, M AU - Georges, H AU - Goldgran-Toledano, D AU - Jourdain, M AU - Loubert, G AU - Reignier, J AU - Saidi, F AU - Souweine, B AU - Vincent, F AU - Barnes, NK AU - Pochard, F AU - Schlemmer, B AU - Azoulay, E PY - 2007/02/01/ UR - http://dx.doi.org/10.1056/NEJMoa063446 ER -