Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care.
Am J Respir Crit Care Med
; 193(2): 154-62, 2016 Jan 15.
Article
in En
| MEDLINE
| ID: mdl-26378963
ABSTRACT
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 MAINRESULTS:
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).Key words
Full text:
1
Database:
MEDLINE
Main subject:
Palliative Care
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Professional-Family Relations
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Stress, Psychological
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Terminal Care
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Family
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Negotiating
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Depression
Type of study:
Clinical_trials
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Etiology_studies
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Aged80
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Female
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Humans
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Male
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Middle aged
Language:
En
Year:
2016
Type:
Article