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

  • 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
Seven-Day Profile Publication

DOI: 10.1007/s00134-016-4669-9

Cite this article as:
Kentish-Barnes, N., Chevret, S., Champigneulle, B. et al. Intensive Care Med (2017). doi:10.1007/s00134-016-4669-9

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.

Keywords

Letter of condolenceBereaved relativesGrief symptoms

Supplementary material

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Supplementary material 2 (DOCX 2198 kb)
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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Nancy Kentish-Barnes
    • 1
  • Sylvie Chevret
    • 2
  • Benoît Champigneulle
    • 3
  • Marina Thirion
    • 4
  • Virginie Souppart
    • 1
  • Marion Gilbert
    • 5
  • Olivier Lesieur
    • 6
  • Anne Renault
    • 7
  • Maïté Garrouste-Orgeas
    • 8
  • Laurent Argaud
    • 9
  • Marion Venot
    • 10
  • Alexandre Demoule
    • 11
  • Olivier Guisset
    • 12
  • Isabelle Vinatier
    • 13
  • Gilles Troché
    • 14
  • Julien Massot
    • 15
  • Samir Jaber
    • 16
  • Caroline Bornstain
    • 17
  • Véronique Gaday
    • 18
  • René Robert
    • 19
  • Jean-Philippe Rigaud
    • 20
  • Raphaël Cinotti
    • 21
  • Mélanie Adda
    • 22
  • François Thomas
    • 23
  • Laure Calvet
    • 24
  • Marion Galon
    • 1
  • Zoé Cohen-Solal
    • 1
  • Alain Cariou
    • 25
  • Elie Azoulay
    • 1
    • 26
  • Famirea Study Group
  1. 1.Assistance Publique, Hôpitaux de ParisSaint-Louis University Hospital, Famiréa Research GroupParisFrance
  2. 2.ECSTRA Team, Biostatistics and Clinical EpidemiologyUMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-LouisParisFrance
  3. 3.Assistance Publique, Hôpitaux de ParisCochin University HospitalParisFrance
  4. 4.Victor Dupouy HospitalArgenteuilFrance
  5. 5.Sud Francilien HospitalCorbeil-EssonnesFrance
  6. 6.La Rochelle HospitalLa RochelleFrance
  7. 7.Cavale Blanche University HospitalBrestFrance
  8. 8.Saint Joseph HospitalParisFrance
  9. 9.Hospices Civils de Lyon, Edouard Herriot HospitalLyon Est UniversityLyonFrance
  10. 10.Assistance Publique, Hôpitaux de ParisSaint-Louis University HospitalParisFrance
  11. 11.Assistance Publique, Hôpitaux de ParisLa Pitié-Salpêtrière University HospitalParisFrance
  12. 12.Saint André University HospitalBordeauxFrance
  13. 13.Les Oudairies HospitalLa Roche sur YonFrance
  14. 14.Versailles HospitalVersaillesFrance
  15. 15.Assistance Publique, Hôpitaux de ParisHôpital Européen Georges PompidouParisFrance
  16. 16.Saint Eloi University Hospital, and Inserm U-1046MontpellierFrance
  17. 17.Le Raincy-Montfermeil HospitalMontfermeilFrance
  18. 18.René-Dubos HospitalPontoiseFrance
  19. 19.Poitiers University Hospital and Poitiers University and Inserm CIC 1402PoitiersFrance
  20. 20.Dieppe HospitalDieppeFrance
  21. 21.Hôtel Dieu University HospitalNantesFrance
  22. 22.Assistance Publique, Hôpitaux de MarseilleHôpital Nord University HospitalMarseilleFrance
  23. 23.Sud Amiens University HospitalAmiensFrance
  24. 24.Gabriel Montpied University HospitalClermont-FerrandFrance
  25. 25.Assistance Publique, Hôpitaux de ParisCochin University Hospital, Paris Descartes UniversityParisFrance
  26. 26.Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERMParis Diderot Sorbonne University ParisFrance