1. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial.
- Author
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Kentish-Barnes N, Chevret S, Valade S, Jaber S, Kerhuel L, Guisset O, Martin M, Mazaud A, Papazian L, Argaud L, Demoule A, Schnell D, Lebas E, Ethuin F, Hammad E, Merceron S, Audibert J, Blayau C, Delannoy PY, Lautrette A, Lesieur O, Renault A, Reuter D, Terzi N, Philippon-Jouve B, Fiancette M, Ramakers M, Rigaud JP, Souppart V, Asehnoune K, Champigneulle B, Goldgran-Toledano D, Dubost JL, Bollaert PE, Chouquer R, Pochard F, Cariou A, and Azoulay E
- Subjects
- Adult, Aged, Empathy, Female, Humans, Intensive Care Units, Male, Middle Aged, Professional-Family Relations, Standard of Care, Attitude to Death, Bereavement, Communication, Family psychology, Grief, Patient Care Team, Terminal Care psychology
- Abstract
Background: In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes., Methods: We undertook a prospective, multicentre, cluster randomised controlled trial in 34 ICUs in France, to compare standard care with a physician-driven, nurse-aided, three-step support strategy for families throughout the dying process, following a decision to withdraw or withhold life support. Inclusion criteria were relatives of patients older than 18 years with an ICU length of stay 2 days or longer. Participating ICUs were randomly assigned (1:1 ratio) into an intervention cluster and a control cluster. The randomisation scheme was generated centrally by a statistician not otherwise involved in the study, using permutation blocks of non-released size. In the intervention group, three meetings were held with relatives: a family conference to prepare the relatives for the imminent death, an ICU-room visit to provide active support, and a meeting after the patient's death to offer condolences and closure. ICUs randomly assigned to the control group applied their best standard of care in terms of support and communication with relatives of dying patients. The primary endpoint was the proportion of relatives with prolonged grief (measured with PG-13, score ≥30) 6 months after the death. Analysis was by intention to treat, with the bereaved relatives as the unit of observation. The study is registered with ClinicalTrials.gov, NCT02955992., Findings: Between Feb 23, 2017, and Oct 8, 2019, we enrolled 484 relatives of ICU patients to the intervention group and 391 to the control group. 379 (78%) relatives in the intervention group and 309 (79%) in the control group completed the 6-month interview to measure the primary endpoint. The intervention significantly reduced the number of relatives with prolonged grief symptoms (66 [21%] vs 57 [15%]; p=0·035) and the median PG-13 score was significantly lower in the intervention group than in the control group (19 [IQR 14-26] vs 21 [15-29], mean difference 2·5, 95% CI 1·04-3·95)., Interpretation: Among relatives of patients dying in the ICU, a physician-driven, nurse-aided, three-step support strategy significantly reduced prolonged grief symptoms., Funding: French Ministry of Health., Competing Interests: Declaration of interests EA reports receiving fees for lectures from Gilead, Pfizer, Baxter, and Alexion. His research group has been supported by Ablynx, Fisher & Payckle, Jazz Pharma, and MSD, outside the submitted work. AC reports receiving fees for lectures from Bard, outside the submitted work. AD reports grants, personal fees, and non-financial support from Philips; personal fees from Baxter; personal fees and non-financial support from Fisher & Paykel; grants from French Ministry of Health; personal fees from Getinge; grants, personal fees, and non-financial support from Respinor; grants, personal fees, and non-financial support from Lungpacer; personal fees from Lowenstein; and personal fees from Gilead, outside the submitted work. SJ reports receiving grants from the French Ministry of Health and Société Française d'Anesthésie Réanimation; and personal fees from Draeger, Hamilton, Maquet, and Fisher Paykel Healthcare, outside the submitted work. KA reports receiving personal fees from Baxter, Fresenius, Medtronic, LFB, and Edwards, outside the submitted work. NT reports personal fees from Pfizer, outside the submitted work. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
- Published
- 2022
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