法国姑息治疗病房中晚期癌症患者亲属持续性悲伤的发生率及危险因素：Fami-Life多中心队列研究

Incidence and risk factors of prolonged grief in relatives of patients with terminal cancer in French palliative care units: The Fami-Life multicenter cohort study.

作者信息

Garrouste-Orgeas Maité, Marché Véronique, Pujol Nicolas, Michel Dominique, Evin Adrien, Fossez-Diaz Virginie, Perruchio Ségolène, Vanbésien Anne, Verlaine Catherine, Copel Laure, Kaczmarek Willeme, Birkui de Francqueville Laurence, Michonneau-Gandon Véronique, de Larivière Emmanuel, Poupardin Cécile, Touzet Licia, Guastella Virginie, Mathias Carmen, Mhalla Alaa, Bouquet Guillaume, Richard Bruno, Gracia Dominique, Bienfait Florent, Verliac Virginie, Ranchou Gaelle, Kirsch Sylvie, Flahault Cécile, Loiodice Ambre, Bailly Sébastien, Ruckly Stéphane, Timsit Jean-François

机构信息

IAME, INSERM, Université de Paris, Paris, France.

Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France.

出版信息

Palliat Support Care. 2024 Oct;22(5):961-970. doi: 10.1017/S1478951523000111.

DOI:10.1017/S1478951523000111

PMID:36878669

Abstract

OBJECTIVES

Psychological consequences of grief among relatives are insufficiently known. We reported incidence of prolonged grief among relatives of deceased patients with cancer.

METHODS

Prospective cohort study of 611 relatives of 531 patients with cancer hospitalized for more than 72 hours and who died in 26 palliative care units was conducted. The primary outcome was prolonged grief in relatives 6 months after patient death, measured with the Inventory Complicated Grief (ICG > 25, range 0-76, a higher score indicates more severe symptoms) score. Secondary outcomes in relatives 6 months after patient death were anxiety and depression symptoms based on Hospital Anxiety and Depression Scale (HADS) score (range 0 [best]-42 [worst]), higher scores indicate more severe symptoms, minimally important difference 2.5. Post-traumatic stress disorder symptoms were defined by an Impact Event Scale-Revised score >22 (range 0-88, a higher score indicates more severe symptoms).

RESULTS

Among 611 included relatives, 608 (99.5%) completed the trial. At 6 months, significant ICG scores were reported by 32.7% relatives (199/608, 95% CI, 29.0-36.4). The median (interquartile range ICG score) was 20.0 (11.5-29.0). The incidence of HADS symptoms was 87.5% (95% CI, 84.8-90.2%) at Days 3-5 and 68.7% (95% CI, 65.0-72.4) 6 months after patient's death, with a median (interquartile range) difference of -4 (-10 to 0) between these 2 time points. Improvement in HADS anxiety and depression scores were reported by 62.5% (362/579) relatives.

SIGNIFICANCE OF RESULTS

These findings support the importance of screening relatives having risk factors of developing prolonged grief in the palliative unit and 6 months after patient's death.

摘要

目的

亲属悲伤的心理后果尚未得到充分了解。我们报告了癌症死亡患者亲属中持续性悲伤的发生率。

方法

对531例住院超过72小时且在26个姑息治疗单位死亡的癌症患者的611名亲属进行了前瞻性队列研究。主要结局是患者死亡6个月后亲属的持续性悲伤，用复杂悲伤量表（ICG>25，范围0-76，分数越高表明症状越严重）评分来衡量。患者死亡6个月后亲属的次要结局是基于医院焦虑抑郁量表（HADS）评分的焦虑和抑郁症状（范围0[最佳]-42[最差]），分数越高表明症状越严重，最小重要差异为2.5。创伤后应激障碍症状由冲击事件量表修订版评分>22（范围0-88，分数越高表明症状越严重）定义。

结果

在纳入的611名亲属中，608名（99.5%）完成了试验。在6个月时，32.7%的亲属（199/608，95%CI，29.0-36.4）报告了显著的ICG评分。中位数（四分位间距ICG评分）为20.0（11.5-29.0）。患者死亡后第3-5天HADS症状的发生率为87.5%（95%CI，84.8-90.2%），6个月时为68.7%（95%CI，65.0-72.4），这两个时间点之间的中位数（四分位间距）差异为-4（-10至0）。62.5%（362/579）的亲属报告HADS焦虑和抑郁评分有所改善。