Lautrette Alexandre, Darmon Michael, Megarbane Bruno, Joly Luc Marie, Chevret Sylvie, Adrie Christophe, Barnoud Didier, Bleichner Gérard, Bruel Cédric, Choukroun Gérald, Curtis J Randall, Fieux Fabienne, Galliot Richard, Garrouste-Orgeas Maité, Georges Hugues, Goldgran-Toledano Dany, Jourdain Mercé, Loubert Georges, Reignier Jean, Saidi Fayçal, Souweine Bertrand, Vincent François, Barnes Nancy Kentish, Pochard Frédéric, Schlemmer Benoit, Azoulay Elie
Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, France.
N Engl J Med. 2007 Feb 1;356(5):469-78. doi: 10.1056/NEJMoa063446.
There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement.
Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference. Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress).
Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs. 20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs. 5 minutes [interquartile range, 5 to 10]). On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs. 39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs. 69%, P=0.01). The median HADS score was also lower in the intervention group (11, vs. 17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs. 67%; P=0.02; depression, 29% vs. 56%; P=0.003).
Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement. (ClinicalTrials.gov number, NCT00331877.)
在重症监护病房（ICU）中，需要与濒死患者的亲属保持密切沟通。我们评估了一种包含主动式临终会议和宣传册的模式，以观察其是否能减轻丧亲之痛的影响。
法国22个ICU中126例濒死患者的家属被随机分配至干预模式组或常规临终会议组。在患者死亡90天后通过电话对参与者进行访谈，使用事件影响量表（IES；分数范围从0表示无症状到75表示与创伤后应激障碍[PTSD]相关的严重症状）和医院焦虑抑郁量表（HADS；子量表分数范围从0表示无痛苦到21表示最大痛苦）。
干预组的会议时间比对照组更长（中位数，30分钟[四分位间距，19至45]对20分钟[四分位间距，15至30]；P<0.001），且谈话时间更多（中位数，14分钟[四分位间距，8至20]对5分钟[四分位间距，5至10]）。在第90天，干预组中56例接受电话访谈的参与者的IES中位数得分显著低于对照组中的52例参与者（27对39，P=0.02），且PTSD相关症状的患病率更低（45%对69%，P=0.01）。干预组的HADS中位数得分也更低（11，对照组为17；P=0.004），焦虑和抑郁症状的患病率均更低（焦虑，45%对67%；P=0.02；抑郁，29%对56%；P=0.003）。
为ICU中濒死患者的亲属提供一本关于丧亲之痛的宣传册，并采用包括更长会议时间和给家属更多谈话时间的主动沟通策略，可能会减轻丧亲之痛的负担。（ClinicalTrials.gov编号，NCT00331877。）
