ATS: End-of-Life Discussions in ICU Reduce Family Members' Grief

SAN FRANCISCO, May 22 -- Better communication with the family of dying ICU patients may reduce stress, anxiety, and depression, French researchers found.

Relatives were about 25% less likely to suffer those outcomes when they took part in a family conference with the patient's physician and nurses and were given a brochure about bereavement, reported lie Azoulay, M.D., Ph.D., of St-Louis Hospital in Paris, and colleagues.

The mnemonic-based communication guidelines provided to the ICU team members in the study may also have relieved their own stress, Dr. Azoulay said here at the American Thoracic Society meeting.

"People were glad to have [the materials] to improve the way they are communicating with families," he said.

The study findings were previously published in the Feb. 1 issue of the New England Journal of Medicine.

From previous studies, Dr. Azoulay said, it was clear that relatives suffer heavy burdens of insomnia, anxiety, guilt, and stress after a family member dies in the ICU.

Because many of the reported concerns centered on bad communication during end-of-life care, the researchers integrated strategies suggested by others into a single program.

They then randomized the families of 126 patients dying in 22 ICUs to either standard end-of-life conferences or the intervention format conference.

The efforts made to contact relatives were similar between groups. Only the content of the communication was different. None of the participating ICUs had already used family conferences or a bereavement-support brochure.

The physicians and nurses who participated did not receive training for the study. Rather, they were provided with the VALUE mnemonic as a guide for the conference. VALUE represented:

• Value what the family members said.
• Acknowledge family members' emotions.
• Listen.
• Understand who the patient was as a person by asking the family questions.
• Elicit questions from the relatives.

The 15-page bereavement brochure given to those in the intervention group was adapted from a similar publication used in pediatric ICUs. It described end-of-life care, possible reactions to loss of a loved one, how to communicate with other family members or children, and where to find assistance in dealing with the loss.

Each participant was contacted 90 days after the intervention by a blinded researcher and questioned using the Impact of Event Scale for post-traumatic stress disorder symptoms and using the Hospital Anxiety and Depression Scale.

The family members included in the conferences were mostly spouses (36% to 42%) and children (42% to 54%).

Among the findings for the intervention group compared with the control group, the researchers reported:

• Family members were more likely to express the patient's wishes (70% versus 54%, P=0.04).
• More family members tended to be at the intervention group conferences (three versus two, P=0.07).
• Conferences were longer (30 minutes versus 20 minutes, P

The findings may be fairly useful as well since "sudden death in the ICU is a rare event" and the 20% of ICU patients who die usually do so in an "orchestrated" manner, he said.