RATIONALE: Communication with family of critically ill patients is often poor and associated with family distress. OBJECTIVES: To determine if an intensive care unit (ICU) communication facilitator reduces family distress and intensity of end-of-life care. METHODS: We conducted a randomized trial at two hospitals. Eligible patients had a predicted mortality greater than or equal to 30% and a surrogate decision maker. Facilitators supported communication between clinicians and families, adapted communication to family needs, and mediated conflict. MEASUREMENTS AND MAIN RESULTS: Outcomes included depression, anxiety, and post-traumatic stress disorder (PTSD) among family 3 and 6 months after ICU and resource use. We identified 488 eligible patients and randomized 168. Of 352 eligible family members, 268 participated (76%). Family follow-up at 3 and 6 months ranged from 42 to 47%. The intervention was associated with decreased depressive symptoms at 6 months (P = 0.017), but there were no significant differences in psychological symptoms at 3 months or anxiety or PTSD at 6 months. The intervention was not associated with ICU mortality (25% control vs. 21% intervention; P = 0.615) but decreased ICU costs among all patients (per patient: $75,850 control, $51,060 intervention; P = 0.042) and particularly among decedents ($98,220 control, $22,690 intervention; P = 0.028). Among decedents, the intervention reduced ICU and hospital length of stay (28.5 vs. 7.7 d and 31.8 vs. 8.0 d, respectively; P < 0.001). CONCLUSIONS:Communication facilitators may be associated with decreased family depressive symptoms at 6 months, but we found no significant difference at 3 months or in anxiety or PTSD. The intervention reduced costs and length of stay, especially among decedents. This is the first study to find a reduction in intensity of end-of-life care with similar or improved family distress. Clinical trial registered with www.clinicaltrials.gov (NCT 00720200).
RCT Entities:
RATIONALE: Communication with family of critically illpatients is often poor and associated with family distress. OBJECTIVES: To determine if an intensive care unit (ICU) communication facilitator reduces family distress and intensity of end-of-life care. METHODS: We conducted a randomized trial at two hospitals. Eligible patients had a predicted mortality greater than or equal to 30% and a surrogate decision maker. Facilitators supported communication between clinicians and families, adapted communication to family needs, and mediated conflict. MEASUREMENTS AND MAIN RESULTS: Outcomes included depression, anxiety, and post-traumatic stress disorder (PTSD) among family 3 and 6 months after ICU and resource use. We identified 488 eligible patients and randomized 168. Of 352 eligible family members, 268 participated (76%). Family follow-up at 3 and 6 months ranged from 42 to 47%. The intervention was associated with decreased depressive symptoms at 6 months (P = 0.017), but there were no significant differences in psychological symptoms at 3 months or anxiety or PTSD at 6 months. The intervention was not associated with ICU mortality (25% control vs. 21% intervention; P = 0.615) but decreased ICU costs among all patients (per patient: $75,850 control, $51,060 intervention; P = 0.042) and particularly among decedents ($98,220 control, $22,690 intervention; P = 0.028). Among decedents, the intervention reduced ICU and hospital length of stay (28.5 vs. 7.7 d and 31.8 vs. 8.0 d, respectively; P < 0.001). CONCLUSIONS: Communication facilitators may be associated with decreased family depressive symptoms at 6 months, but we found no significant difference at 3 months or in anxiety or PTSD. The intervention reduced costs and length of stay, especially among decedents. This is the first study to find a reduction in intensity of end-of-life care with similar or improved family distress. Clinical trial registered with www.clinicaltrials.gov (NCT 00720200).
Authors: Daliana Peres Bota; Christian Melot; Flavio Lopes Ferreira; Vinh Nguyen Ba; Jean-Louis Vincent Journal: Intensive Care Med Date: 2002-09-06 Impact factor: 17.440
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Authors: Bernd Löwe; Robert L Spitzer; Kerstin Gräfe; Kurt Kroenke; Andrea Quenter; Stephan Zipfel; Christine Buchholz; Steffen Witte; Wolfgang Herzog Journal: J Affect Disord Date: 2004-02 Impact factor: 4.839
Authors: Lawrence J Schneiderman; Todd Gilmer; Holly D Teetzel; Daniel O Dugan; Jeffrey Blustein; Ronald Cranford; Kathleen B Briggs; Glen I Komatsu; Paula Goodman-Crews; Felicia Cohn; Ernlé W D Young Journal: JAMA Date: 2003-09-03 Impact factor: 56.272
Authors: Paul R Duberstein; Paul K Maciejewski; Ronald M Epstein; Joshua J Fenton; Benjamin Chapman; Sally A Norton; Michael Hoerger; Marsha N Wittink; Daniel J Tancredi; Guibo Xing; Supriya Mohile; Richard L Kravitz; Holly G Prigerson Journal: J Palliat Med Date: 2019-06-25 Impact factor: 2.947
Authors: Neil P Roberts; Neil J Kitchiner; Justin Kenardy; Lindsay Robertson; Catrin Lewis; Jonathan I Bisson Journal: Cochrane Database Syst Rev Date: 2019-08-08
Authors: Alexia M Torke; Christopher M Callahan; Greg A Sachs; Lucia D Wocial; Paul R Helft; Patrick O Monahan; James E Slaven; Kianna Montz; Emily S Burke; Lev Inger Journal: J Gen Intern Med Date: 2017-11-28 Impact factor: 5.128