Hospitals that use a simple strategy of enhancing communication with family members of patients dying in the intensive care unit can greatly reduce post-traumatic stress disorder, anxiety and depression after their loved one dies, according to a study to be presented at the American Thoracic Society International Conference in San Francisco on Monday, May 21.
The multicenter trial found that family members who engaged in an average of 30 minutes of a family conference with the patient's physician and received an in-depth bereavement booklet had a lower prevalence of post-traumatic stress syndrome after 90 days (44.6% compared with 69.2% for family members who went through a 20-minute family conference and did not receive the bereavement booklet). The group that received more counseling was also less likely to have symptoms of anxiety (44.6% vs. 67.3%), and depression (28.6% vs. 55.8%).
The study included family members of 126 patients dying in 22 ICUs in France.
"The huge effect of the intervention is surprising," says lead researcher Elie Azoulay, M.D., of Hopital Saint-Louis in Paris. "We cannot compare our levels of family symptoms of anxiety, depression and post-traumatic stress syndrome with those from other countries," he noted. "We are looking forward to conducting international comparative studies or to comparing these symptoms with those from other countries."
The 15-page leaflet used in the study describes and explains end-of-life care, possible reactions after the death of a family member, how to communicate with other family members or children, and where to find assistance.
Dr. Azoulay said that families of dying patients in the ICU need information on the causes and the timing of death; the amount or level of healthcare the patient will receive; and information on the process of withholding and withdrawing life-sustaining treatment. "The patient must be comfortable at all times and family and friends must be given opportunities to express emotions and to voice concerns in a private place," he said.