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Relatives of patients in situation of withholding and withdrawing life-sustaining therapies often show post traumatic stress disorder (PTSD) (60%)[1]. This number is even greater when family members are active in this decision (81%) or when communication is not optimal between medical team and family members.
There are several ways to assist families of patients in intensive care units [2], amongst them the use of a written document to explain the environment, therapies and possible outcomes.
Here the investigators want to test the impact of a written document in the context of end-of-life conference in intensive care units. Specifically, this research addresses wether such written support could decrease 3-months post-traumatic stress disorder, anxiety and depression exhibited by the closest family member or the patient representative.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Written document | Experimental | Accompanying relatives with a written document when discussing withholding and withdrawing life-sustaining therapies . All other procedures are standard. |
|
| Standard | Active Comparator | Discussing withholding and withdrawing life-sustaining therapies following standard procedure without written document |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Explaining withholding and withdrawing life-sustaining therapies along with a written document | Other | The document describes the law and the role of family members and medical team in the decision. |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of PTSD | PTSD is assessed with Impact Event Scale (IES) on the family representative | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of depression | Depression is assessed with Hospital Anxiety and Depression scale (HADS) on the family representative | 3 months |
| Rate of anxiety | Anxiety is assessed with Hospital Anxiety and Depression scale (HADS) on the family representative |
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The study will enroll patient representant (family member or close friends designed by the family or pre-admission legal representant).
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Anesthesiology and Critical Care Depratment, Grenoble University Hospital | Grenoble | 38043 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15665319 | Background | Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005 May 1;171(9):987-94. doi: 10.1164/rccm.200409-1295OC. Epub 2005 Jan 21. | |
| 22914431 |
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| Explaining withholding and withdrawing life-sustaining therapies following standard procedure | Other |
|
| 3 months |
| Mean level of HADS (anxiety and depression subscales) | 3 months |
| Mean level of IES | 3 months |
| Length of the processus from decision to withhold and withdraw life-sustaining therapies to intensive care unit (ICU) discharge | An average of 6 days |
| Respectfulness of the law regarding withholding and withdrawing life-sustaining therapies | An average of 6 days |
| Rate of decision to withhold and withdraw life-sustaining therapies in different intensive care units from the hospital | ICU discharge (an average of 3 weeks) |
| Medical Doctor satisfaction with the processus | ICU discharge (an average of 3 weeks) |
| Description of the processus | ICU discharge (an average of 3 weeks) |
| Background |
| Schmidt M, Azoulay E. Having a loved one in the ICU: the forgotten family. Curr Opin Crit Care. 2012 Oct;18(5):540-7. doi: 10.1097/MCC.0b013e328357f141. |
| 33549600 | Derived | Robin S, Labarriere C, Sechaud G, Dessertaine G, Bosson JL, Payen JF. Information Pamphlet Given to Relatives During the End-of-Life Decision in the ICU: An Assessor-Blinded, Randomized Controlled Trial. Chest. 2021 Jun;159(6):2301-2308. doi: 10.1016/j.chest.2021.01.072. Epub 2021 Feb 5. |
| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
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