Information Pamphlet Given to Relatives During the End-of-Life Decision in the ICU

Robin, Sylvaine; Labarriere, Cyrielle; Séchaud, Guillaume; Dessertaine, Géraldine; Bosson, Jean‐Luc; Payen, Jean‐François

doi:10.1016/j.chest.2021.01.072

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…All but two (34, 36) interventions modified care processes in the ICU to enhance psychological support and communication between surrogates and ICU staff, many including protocolized encounters with surrogates (33, 37, 38, 40, 44) and written materials (i.e., leaflet or pamphlet) (33, 37, 39, 45). Only one intervention was delivered outside of the ICU: a condolence letter mailed to bereaved surrogates (36).…”

Section: Resultsmentioning

confidence: 99%

“…The “Leonetti law” stipulates that the “trusted person” (surrogate) represents the patient and their wishes but does not make end-of-life decisions; these decisions are made by the physician in charge (72). Indeed, Robin et al (45) designed their intervention as a written reminder to surrogates of the Leonetti law and that they do not share responsibility for end-of-life decisions. These sociolegal differences are important factors to consider when interpreting trial results.…”

Section: Discussionmentioning

confidence: 99%

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Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis

DeForge

George

Baldwin

et al. 2022

Critical Care Medicine

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OBJECTIVES: Evaluate the efficacy of interventions to improve symptoms for ICU surrogates at highest risk of developing psychologic distress: those facing end-of-life care decisions. DATA SOURCES: MEDLINE, CINAHL, PsycInfo, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched through April 16, 2022. STUDY SELECTION: Following an a priori protocol, randomized trials of interventions delivered to surrogates of adult ICU patients who died or had high likelihood of mortality evaluating surrogate symptoms were identified. DATA EXTRACTION: Two reviewers performed screening and data extraction and assessed risk of bias (Cochrane Risk of Bias [RoB] 2 tool). Trials were eligible for meta-analysis if group mean symptom scores were provided at 3 or 6 months. Pooled effects were estimated using a random effects model. Heterogeneity was assessed (Cochrane Q, I2). Certainty of evidence was assessed (Grading of Recommendations Assessment, Development and Evaluation). DATA SYNTHESIS: Of 1,660 records, 10 trials met inclusion criteria representing 3,824 surrogates; eight were included in the meta-analysis. Overall RoB was rated Some Concerns. Most (n = 8) interventions focused on improving communication and enhancing psychologic support in the ICU. All trials measured anxiety, depression, and posttraumatic stress. Significant improvement was seen at 3 months (depression, mean difference [MD], –0.68; 95% CI, –1.14 to –0.22, moderate certainty; posttraumatic stress, standardized MD, –0.25; 95% CI, –0.49 to –0.01, very low certainty) and 6 months (anxiety, MD, –0.70; 95% CI, –1.18 to –0.22, moderate certainty). Sensitivity analyses suggest significant findings may be unstable. Subgroup analyses demonstrated differences in effect by trial location, interventionist, and intervention dose. CONCLUSIONS: Communication and psychological support interventions in the ICU yielded small but significant improvement in psychological symptoms with moderate to very low certainty evidence in a prognostically-enriched sample of ICU surrogates facing end-of-life care decisions. A new approach to interventions that extend beyond the ICU may be needed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis

DeForge

George

Baldwin

et al. 2022

Critical Care Medicine

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“…Symptoms of posttraumatic stress are very frequent among families. In this issue of CHEST, Robin et al, 3 with the use of a structured communication that included a pamphlet that described the role of family members and explained that they do not have responsibility for end-of-life decisions (according to French law on the end-of-life process), showed that one can lessen their psychologic burden.…”

mentioning

confidence: 99%

“…Remarkably, in the French setting, as highlighted by the pamphlet presented in electronic supplementary material, 3 the final decisions weigh only on the shoulders of the doctors. This is a key message for reassuring families, because it attenuates any feelings of guilt.…”

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confidence: 99%

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When the Words Serve As Drugs

Mistraletti

Giannini

2021

Chest

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Mobile App–Facilitated Collaborative Palliative Care Intervention for Critically Ill Older Adults

Cox,

Ashana,

Dempsey

et al. 2024

JAMA Intern Med

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ImportanceFew person-centered, scalable models of collaborative intensive care unit (ICU) clinician–palliative care specialist care exist.ObjectiveTo evaluate the effect of a collaborative palliative care intervention compared to usual care among family members of patients in the ICU.Design, Setting, and ParticipantsThis parallel-group randomized clinical trial with patient-level randomization was conducted between April 2021 and September 2023. The study was set at 6 medical and surgical ICUs in 1 academic hospital and 1 community hospital. The study participants included critically ill older adult patients with 1 of 11 poor outcome phenotypes, their family members with elevated palliative care needs, and their attending ICU physicians.InterventionAn automated electronic health record–integrated, mobile application–based communication platform that displayed family-reported needs over 7 days, coached ICU attending physicians on addressing needs, and prompted palliative care consultation if needs were not reduced within 3 study days.Main Outcomes and MeasuresThe primary outcome was change in the family-reported Needs at the End-of-Life Screening Tool (NEST) score between study days 1 and 3. The 13-item NEST score is a number between 0 and 130, with higher scores indicating a greater need. Secondary outcomes included quality of communication and goal of care concordance, as well as 3-month psychological distress.ResultsOf 151 family members, the mean (SD) age was 57.4 (12.9) years, and 110 (72.9%) were female. Of 151 patients, the mean (SD) age was 69.8 (9.7) years, and 86 (57.0%) were male. Thirty-five ICU physicians were male (68.6%). Seventy-six patients were randomized to the intervention group and 75 to the control group. Treatment group differences in estimated mean NEST scores were similar at 3 days between the intervention and control groups (−3.1 vs −2.0, respectively; estimated mean difference in differences, −1.3 points [95% CI, −6.0 to 3.5]) and 7 days (−2.3 vs −2.2, respectively; estimated mean difference in differences, 0 points [95% CI, −6.2 to 6.2]). Median (IQR) need scores were lower among individuals who remained in the ICU at day 3 for intervention participants vs controls (24.5 [16.5-34.5] vs 27.5 [13.0-40.0], respectively); median (IQR) need scores were also lower among those who remained in the ICU at day 7 for intervention vs controls (22.0 [11.0-35.0] vs 28.0 [14.0-35.0], respectively). Goal concordance, quality of communication, and psychological distress symptoms did not differ. Twenty-nine intervention participants (38.2%) had palliative care consultations, compared to only 3 (4.0%) among controls, (P &lt; .001); 66 intervention participants (87.0%) had a family meeting, compared to 48 (64.0%) among controls (P = .001).Conclusions and RelevanceIn this randomized clinical trial, a collaborative, person-centered, ICU-based palliative care intervention had no effect on palliative care needs or psychological distress compared to usual care despite a higher frequency of palliative care consultations and family meetings among intervention participants.Trial RegistrationClinicalTrials.gov Identifier: NCT04414787

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Information Pamphlet Given to Relatives During the End-of-Life Decision in the ICU

Cited by 14 publications

References 25 publications

Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis

Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis

When the Words Serve As Drugs

Mobile App–Facilitated Collaborative Palliative Care Intervention for Critically Ill Older Adults

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