CAESAR: a new tool to assess relatives' experience of dying and death in the ICU

Nancy Kentish-Barnes 1 Stephane Legriel Valerie Seegers Alain Cariou 2 Samir Jaber 3, 4 Jean Yves Lefrant 5, 6 Bernard Floccard Anne Renault 7 Isabelle Vinatier 8 Armelle Mathonnet 9 Danielle Reuter Olivier Guisset 10 Christophe Cracco 11, 12 Amélie Seguin 13 Hugues Georges 14 Jacques Durand-Gasselin Beatrice Eon Marina Thirion Jean-Philippe Rigaud 15 Benedicte Philippon-Jouve Laurent Argaud 16 Renaud Chouquer Melanie Adda Laurent Papazian 17 Celine Dedrie Gerald Viquesnel Eddy Lebas Nathalie Rolin Pierre-Edouard Bollaert 18 Lucien Lecuyer 19 Marc Leone 17 Ludivine Chalumeau-Lemoine 20 Zoe Cohen-Solal Maïté Garrouste-Orgeas 21 Fabienne Tamion 22, 23 Bruno Falissard 24, 25 Sylvie Chevret 26, 27 Élie Azoulay 28
Abstract : Purpose: To develop an instrument designed specifically to assess the experience of relatives of patients who die in the intensive care unit (ICU). Methods: The instrument was developed using a mixed methodology and validated in a prospective multicentre study. Relatives of patients who died in 41 ICUs completed the questionnaire by telephone 21 days after the death, then completed the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Inventory of Complicated Grief after 3, 6, and 12 months. Results: A total of 600 relatives were included, 475 in the main cohort and 125 in the reliability cohort. The 15-item questionnaire, named CAESAR, covered the patient's preferences and values, interactions with/around the patient and family satisfaction. We defined three groups based on CAESAR score tertiles: lowest (<= 59, n = 107, 25.9 %), middle (n = 185, 44.8 %) and highest (>= 69, n = 121, 29.3 %). Factorial analysis showed a single dimension. Cronbach's alpha in the main and reliability cohorts was 0.88 (0.85-0.90) and 0.85 (0.79-0.89), respectively. Compared to a high CAESAR score, a low CAESAR score was associated with greater risks of anxiety and depression at 3 months [1.29 (1.13-1.46), p = 0.001], post-traumatic stress-related symptoms at 3 [1.34 (1.17-1.53), p < 0.001], 6 [OR = 1.24 (1.06-1.44), p = 0.008] and 12 [OR = 1.26 (1.06-1.50), p = 0.01] months and complicated grief at 6 [OR = 1.40 (1.20-1.63), p < 0.001] and 12 months [OR = 1.27 (1.06-1.52), p = 0.01]. Conclusions: The CAESAR score 21 days after death in the ICU is strongly associated with post-ICU burden in the bereaved relatives. The CAESAR score should prove a useful primary endpoint in trials of interventions to improve relatives' well-being.
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Intensive Care Medicine, Springer Verlag, 2016, 42 (6), pp.995-1002. 〈10.1007/s00134-016-4260-4〉
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Soumis le : lundi 6 février 2017 - 18:59:56
Dernière modification le : vendredi 16 novembre 2018 - 02:10:18

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Nancy Kentish-Barnes, Stephane Legriel, Valerie Seegers, Alain Cariou, Samir Jaber, et al.. CAESAR: a new tool to assess relatives' experience of dying and death in the ICU. Intensive Care Medicine, Springer Verlag, 2016, 42 (6), pp.995-1002. 〈10.1007/s00134-016-4260-4〉. 〈hal-01458388〉

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