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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2017

01-04-2017 | Seven-Day Profile Publication

Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial

Authors: Nancy Kentish-Barnes, Sylvie Chevret, Benoît Champigneulle, Marina Thirion, Virginie Souppart, Marion Gilbert, Olivier Lesieur, Anne Renault, Maïté Garrouste-Orgeas, Laurent Argaud, Marion Venot, Alexandre Demoule, Olivier Guisset, Isabelle Vinatier, Gilles Troché, Julien Massot, Samir Jaber, Caroline Bornstain, Véronique Gaday, René Robert, Jean-Philippe Rigaud, Raphaël Cinotti, Mélanie Adda, François Thomas, Laure Calvet, Marion Galon, Zoé Cohen-Solal, Alain Cariou, Elie Azoulay, Famirea Study Group

Published in: Intensive Care Medicine | Issue 4/2017

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Abstract

Purpose

Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the closest relative a handwritten condolence letter.

Methods

Multicenter randomized trial conducted among 242 relatives of patients who died at 22 ICUs in France between December 2014 and October 2015. Relatives were randomly assigned to receiving (n = 123) or not receiving (n = 119) a condolence letter. The primary endpoint was the Hospital Anxiety and Depression Score (HADS) at 1 month. Secondary endpoints included HADS, complicated grief (ICG), and PTSD-related symptoms (IES-R) at 6 months. Observers were blinded to group allocation.

Results

At 1 month, 208 (85.9%) relatives completed the HADS; median score was 16 [IQR, 10–22] with and 14 [8–21.5] without the letter (P = 0.36). Although scores were higher in the intervention group, there were no significant differences regarding the HADS-depression subscale (8 [4–12] vs. 6 [2–12], mean difference 1.1 [−0.5 to 2.6]; P = 0.09) and prevalence of depression symptoms (56.0 vs. 42.4%, RR 0.76 [0.57–1.00]; P = 0.05). At 6 months, 190 (78.5%) relatives were interviewed. The intervention significantly increased the HADS (13 [7–19] vs. 10 [4–17.5], P = 0.04), HADS-depression subscale (6 [2–10] vs. 3 [1–9], P = 0.02), prevalence of depression symptoms (36.6 vs. 24.7%, P = 0.05) and PTSD-related symptoms (52.4 vs. 37.1%, P = 0.03).

Conclusions

In relatives of patients who died in the ICU, a condolence letter failed to alleviate grief symptoms and may have worsened depression and PTSD-related symptoms.
Trial registration Clinicaltrials.gov Identifier: NCT02325297.
Appendix
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Metadata
Title
Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial
Authors
Nancy Kentish-Barnes
Sylvie Chevret
Benoît Champigneulle
Marina Thirion
Virginie Souppart
Marion Gilbert
Olivier Lesieur
Anne Renault
Maïté Garrouste-Orgeas
Laurent Argaud
Marion Venot
Alexandre Demoule
Olivier Guisset
Isabelle Vinatier
Gilles Troché
Julien Massot
Samir Jaber
Caroline Bornstain
Véronique Gaday
René Robert
Jean-Philippe Rigaud
Raphaël Cinotti
Mélanie Adda
François Thomas
Laure Calvet
Marion Galon
Zoé Cohen-Solal
Alain Cariou
Elie Azoulay
Famirea Study Group
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 4/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4669-9

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