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

Nancy Kentish-Barnes (1) , Sylvie Chevret (2, 3) , Benoit Champigneulle (4) , Marina Thirion (5) , Virginie Souppart (1) , Marion Gilbert (6) , Olivier Lesieur (7) , Anne Renault (8) , Maïté Garrouste-Orgeas (9) , Laurent Argaud (10, 11) , Marion Venot (1) , Alexandre Demoule (12) , Olivier Guisset (13) , Isabelle Vinatier (14) , Gilles Troché (15) , Julien Massot (16) , Samir Jaber (17, 18) , Caroline Bornstain (19) , Véronique Gaday (20) , René Robert (21) , Jean-Philippe Rigaud (22) , Raphaël Cinotti (23) , Melanie Adda (24) , François Thomas (25) , Laure Calvet (26) , Marion Galon (1) , Zoé Cohen-Solal (1) , Alain Cariou (4) , Élie Azoulay (1, 2)

1 Hôpital Saint-Louis
2 CRESS - U1153 - Equipe 2 : ECSTRA - Epidémiologie Clinique, STatistique, pour la Recherche en Santé
3 Service de biostatistiques et information médicale [Saint-Louis]
4 Hôpital Cochin [AP-HP]
5 Hôpital Victor Dupouy
6 Centre Hospitalier Sud Francilien
7 CH La Rochelle
8 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
9 Centre hospitalier Saint-Joseph [Paris]
10 Hôpital Edouard Herriot [CHU - HCL]
11 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
12 CHU Pitié-Salpêtrière [AP-HP]
13 Hôpital Saint-André
14 Centre Hospitalier Départemental Les Oudairies
15 CHV - Centre Hospitalier de Versailles André Mignot
16 HEGP - Hôpital Européen Georges Pompidou [APHP]
17 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
18 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
19 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil
20 Centre Hospitalier René Dubos [Pontoise]
21 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
22 Centre hospitalier de Dieppe
23 CHU Nantes - Centre Hospitalier Universitaire de Nantes
24 Hôpital Nord [CHU - APHM]
25 CHU Amiens-Picardie
26 CHU Gabriel Montpied [Clermont-Ferrand]

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.

Mots clés: Letter of condolence; Bereaved relatives; Grief symptoms

Domaines: Psychiatrie et santé mentale; Santé publique et épidémiologie

Nancy Kentish-Barnes, Sylvie Chevret, Benoit Champigneulle, Marina Thirion, Virginie Souppart, et al.. Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial. Intensive Care Medicine, 2017, 43 (4), pp.473-484. ⟨10.1007/s00134-016-4669-9⟩. ⟨hal-01783552⟩