Three-step support strategy reduces prolonged grief in relatives after death of intensive care unit patients

1. Grief measured at 6 months following the patient’s death was significantly lower in relatives in the intervention groups compared to control.

2. Symptoms of anxiety and PTSD were lower in relatives in the intervention group at 6 months.

Evidence Rating Level: 2 (Good)

Study Rundown: A large part of the role of an intensive care unit (ICU) physician is providing support to the relatives of patients in the ICU. The goal of this randomized-controlled trial was to evaluate the benefit of a structured three-step support strategy for ICU physicians and nurses when speaking to a patient’s relatives. The strategy focused on three key timepoints in end-of-life care: before a patient’s death, during a patient’s death and after a patient’s death. Those randomized to the control group provided their best standard of care regarding support and communication with the relatives of the patient. The results of this study showed that the three-step proactive approach significantly reduced the length of prolonged grief among relatives of an ICU patient after their death. Other outcomes, such as symptoms of anxiety, were also reduced. Limitations of this study include being only done in one country (France) where results may not be applicable in other cultures. Nonetheless, this study provides a valuable insight for the management of prolonged grief symptoms of family members of patients in the ICU.

Click to read the study in The Lancet

Relevant Reading: Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU

In-Depth [randomized controlled trial]: This randomized controlled trial involved 34 French ICUs which were assigned 1:1 to either control or intervention groups. The intervention was defined as three meetings between the physician, nurse, and the patient’s relative. All clinicians assigned to the intervention group received educational training on end-of-life communication, including how to use the three-step communication strategy. The goal of these meetings was to provide attentive listening to the family of the patient and allow them to ask questions. The first meeting was before the patient’s death (“end-of-life conference”), the second during the dying process and the third after the patient’s death. Throughout each meeting, relatives of the patients were encouraged to ask questions and express their emotions. The control group was advised to provide their best standard of care and communication. A total of 875 relatives were included in the trial (n=484 in intervention group). The primary outcome measured was the proportion of relatives with prolonged grief 6 months after the death (PG-13 score ≥30). The three-step proactive intervention significantly reduced the proportion of patients with prolonged grief after 6-months compared to the control group (15% vs. 21%, respectively; p=0.035). The PG-13 score was also significantly lower in the intervention group (19 [IQR 14-26]) compared to the control group (21 [15-29]) at 6 months following the death of the patient (mean difference 2.5, 95% CI 1.04-3.95).

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