Communication with bereaved family members after death in the ICU: the CATHARTIC randomised clinical trial

Abstract

OBJECTIVE: It is uncertain whether psychological distress in the family members of patients who die during an intensive care unit (ICU) admission may be improved by bereavement interventions. In this trial, relatives' symptoms of anxiety and depression after 6 months were measured when allocated to three commonly used bereavement follow-up strategies. DESIGN: Single-centre, randomised, three parallel-group trial. SETTING: A tertiary ICU in Australia. PARTICIPANTS: Relatives of patients who died in the ICU. INTERVENTIONS: Relatives received bereavement follow-up 4 weeks after the death using a condolence letter, short telephone call or no contact. MAIN OUTCOME MEASURES: The primary outcome was the total Hospital Anxiety and Depression Scale (HADS-T) score. Secondary outcomes estimated anxiety, depression, complicated grief, post-traumatic stress, and satisfaction with ICU care. RESULTS: Seventy-one relatives participated (24 had no contact, 19 were contacted by letter and 28 by telephone 4 weeks after the death). The mean HADS-T score for no contact was 16.1 (95% CI, 12.4–19.8). Receipt of a letter was associated with a mean HADS-T increase of 1.4 (4.0 decrease to 6.8 increase), and a condolence call was accompanied by a mean decrease of 1.6 (6.6 decrease to 3.4 increase; P > 0.5). Non-significant differences were observed for all secondary outcomes. CONCLUSIONS: Anxiety and depression at 6 months in the relatives of patients who died in the ICU was not meaningfully alleviated by receipt of either a condolence letter or telephone call. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry (ACTRN12619000917134).

Recent advances in critical care

“…In a multicentre randomised trial of 242 relatives of patients who died in French ICUs, a handwritten letter from the treating doctor and nurse actually increased symptoms of depression (36.6% v 24.7%; P = 0.05) and PTSD (52.4% v 37.1%; P = 0.03) at 6 months compared with standard care 19 . Similarly, a recent three parallel‐group randomised trial in an Australian ICU found that anxiety, depression and PTSD symptoms in 71 bereaved relatives were not alleviated by either a condolence letter or a telephone call from hospital staff 20 …”

“…19 Similarly, a recent three parallelgroup randomised trial in an Australian ICU found that anxiety, depression and PTSD symptoms in 71 bereaved relatives were not alleviated by either a condolence letter or a telephone call from hospital staff. 20 A recent systematic review and meta-analysis identified significant variability in the design, implementation and assessment of ICU bereavement support programs. 21 The meta-analysis of three studies of written support materials and two studies of narration of relatives' experiences in the ICU demonstrated no effect on anxiety and depression.…”