Support intervention reduces grief for relatives of patients dying in ICU

A three-step support strategy significantly reduced prolonged grief symptoms among relatives of patients dying in the ICU, according to results of a cluster randomized trial published in The Lancet.

“Many studies have shown that communication with ICU clinicians is one of the most highly valued aspects of care and has a major effect on relatives’ experience throughout the patient’s stay, including during the end of life (EOL), as well as after the patient’s death,” Nancy Kentish-Barnes, PhD, of Saint Louis Hospital in France, and colleagues wrote. “Communication difficulties with ICU clinicians at the EOL are well documented. Missed opportunities are common: the family’s emotions are not always addressed, non-abandonment not consistently affirmed (providing continuity and facilitating closure) and palliative care not always discussed.”

According to the researchers, a prior study showed that unsatisfactory communication that lacks adequate quality of information, empathy, support, and attention to nonverbal cues and words correlated with an increased risk for post-ICU burden.

In the current study, they sought to examine whether a physician-driven, nurse-aided intervention that incorporated proactive communication and support for families throughout the dying process, following a decision to withdraw or withhold life support, would benefit relatives’ outcomes compared with standard care. They conducted the trial at 34 ICUs in France among relatives of patients older than age 18 years who were in an ICU for 2 days or longer.

Researchers randomly assigned participating ICUs in a 1:1 ratio to intervention and control clusters. The intervention group featured three meetings with relatives, which included a family conference to prepare relatives for the approaching death, a visit in the ICU room to provide active support and a meeting following the patient’s death to provide condolences and closure.

ICUs in the control group used their best standard of care regarding support and communication with relatives of dying patients. The proportion of relatives with prolonged grief based on a prolonged grief-13 (PG-13) questionnaire score of 30 or greater 6 months after the death served as the primary endpoint.

Kentish-Barnes and colleagues received 6-month interview responses from 379 relatives in the intervention group and 309 in the control group. Results showed a significant reduction in the number of relatives with prolonged grief symptoms (66 vs. 57; P = .035) and significantly lower PG-13 scores (19 vs. 21; mean difference, 2.5; 95% CI, 1.04-3.95) in the intervention group compared with the control group.

“A three-step, physician-driven, nurse-aided support strategy decreased the prevalence of prolonged grief disorder among bereaved relatives,” Kentish-Barnes and colleagues wrote. “PTSD-related symptoms, as well as symptoms of anxiety, were less common in the intervention group than in the control group. The communication style used in the intervention deserves to be used widely in ICUs.”