End-of-Life Communication Helps Families Cope With Loss

Just 10 extra minutes with health-care providers reduced stress and depression, study finds

WEDNESDAY, Jan. 31, 2007 (HealthDay News) -- When doctors spent 10 minutes more than usual listening to the families of people dying in the intensive care unit and provided them with a brochure on bereavement, those family members were far less likely to suffer from stress, anxiety or depression after the death of their loved one.

That's the conclusion of a new French study published in the Feb. 1 issue of the New England Journal of Medicine. The study authors found that when doctors approached grieving families and took more time to listen, they could reduce stress symptoms by 24 percent, anxiety symptoms by 22 percent and depression symptoms by 27 percent.

"This randomized controlled trial shows that a proactive communication strategy is efficient to alleviate symptoms of stress, anxiety and depression in relatives of critically ill, dying patients," said the study's lead author, Dr. Elie Azoulay, assistant director of the medical intensive-care unit at Saint-Louis Hospital in Paris.

Having a family member in the ICU is very stressful on family members, particularly since their loved ones often can't speak, according to background information for the study. An end-of-life conference, in which family members meet with the ICU team, has become standard in many medical centers. But this practice hadn't been evaluated in a randomized, controlled trial, according to the study authors.

For the new study, the researchers enrolled the family members of 126 dying ICU patients from 22 intensive-care units in France. Half of the family members participated in a standard end-of-life conference, which generally lasts about 20 minutes. The other half participated in a more proactive, longer-lasting -- about 30 minutes -- end-of-life conference, during which they were encouraged to ask questions and voice concerns, and they were provided a bereavement brochure at the end of the session.

Participants in the proactive communication group spoke about 9 minutes more, on average, than those in the standard care group.

Ninety days after the death of their loved ones, all of the study participants were interviewed by phone. The proactive communication group had a lower incidence of post-traumatic stress disorder symptoms than the standard group: 45 percent versus 69 percent. Anxiety symptoms were present in 45 percent of the proactive communication group, compared to 67 percent of the standard care group. And depression symptoms were present in 29 percent of the proactive group, compared to 56 percent of the standard care group.

Asked if these findings would likely be replicated in the United States, Dr. Craig Lilly, who co-authored an accompanying editorial in the same issue of the journal, said, "The basic messages are almost certainly translatable. If you spend an extra 10 minutes listening to families, not talking at them, but listening, stress levels will be less.

"When your family member is in crisis, it's important to spend time talking to your doctor about your loved one's values and about what kind of functional outcome they would want," said Lilly, who is a professor of medicine, anesthesiology and surgery at the University of Massachusetts Memorial Medical Center in Worcester.

If your loved one's physician or health-care team doesn't approach you, Lilly said to request a meeting with the doctors and nurses involved and have all the important family members present as well, to make it an efficient communication session for all concerned.

"Those formal communication sessions can be helpful on both sides. Family members should come prepared. Tell the doctors what the patient's values are and what they wanted; what the goals of care should be. Good communication helps everyone understand the available options and know what to expect," Lilly said.

More information

The Society of Critical Care Medicine has advice on taking care of yourself while your loved one is in intensive care.

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