1. Chu, Julie MSN

Article Content

According to this study:


* Holding longer end-of-life conferences can significantly reduce the incidence of posttraumatic stress disorder, anxiety, and depression in the families of patients who die in the ICU.



When dying patients' family members participated in end-of-life conferences that incorporated formalized communication guidelines and bereavement literature, they reported significantly less stress, anxiety, and depression after the death.


Researchers at 22 ICUs in France randomly assigned 126 family members to participate either in a conventional end-of-life family conference (control group, n = 63) or in a conference incorporating the "VALUE" communication guideline, which has five objectives for clinicians: to value what family members say, to acknowledge their emotions, to listen, to understand the patient as a person by asking questions, and to elicit questions from the family members (intervention group, n = 63). After the conference, intervention participants also received a brochure on bereavement. Only the families of patients who were at least 18 years old and who the physician expected to die within a few days were included. Three months after a patient's death, one member of the family was interviewed by telephone to assess for posttraumatic stress disorder according to the Impact of Event Scale (IES) score and anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) score.


Researchers found that conference time for the intervention group was significantly longer than for the control group, with median lengths of 30 and 20 minutes, respectively, and that they involved a median of three family members who spoke for a median of 13.5 minutes, compared with a median of two family members who spoke for a median of five minutes, respectively. More participants in the intervention group than the control group reported that they were able to express their emotions to the clinicians (95% and 75%, respectively). The patient's nurse was present at 81% of the conferences for the intervention group, compared with 60% of those for the control group.


Fifty-six participants in the intervention group and 52 in the control group were interviewed. The median IES score (range, 0 to 75) in the intervention group was 27, while in the control group it was 39; correspondingly, 45% of the intervention group had symptoms of posttraumatic stress disorder compared with 69% of the control group. The median HADS score (range, 0 to 21) in the intervention group was 11, compared with 17 in the control group; 45% of the intervention group and 67% of the control group showed symptoms of anxiety, whereas 29% of the intervention group and 56% of the control group had symptoms of depression.


The study's limitations include the limited inclusion criteria, the inability to assess whether participants read the bereavement literature, and the possible influence of the paternalistic relationship between physicians and patients in France, which might limit the generalizability of the findings. Nevertheless, the study indicates that improving communication with dying patients' family members in the ICU can lower the incidence of posttraumatic stress disorder, depression, and anxiety after the death. According to an accompanying editorial, end-of-life conferences are essential to help family members understand the options in care that are available and to help them make informed decisions.




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