Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care

J. Randall Curtis, Patsy D. Treece, Elizabeth L. Nielsen, Julia Gold, Paul S. Ciechanowski, Sarah Shannon, Nita Khandelwal, Jessica P. Young, Ruth A. Engelberg

Research output: Contribution to journalArticle

114 Scopus citations

Abstract

Rationale: Communication with family of critically ill patients is often poor and associated with family distress. Objectives: To determine if an intensive care unit (ICU) communication facilitator reduces family distress and intensity of end-of-life care. Methods: We conducted a randomized trial at two hospitals. Eligible patients had a predicted mortality greater than or equal to 30% and a surrogate decision maker. Facilitators supported communication between clinicians and families, adapted communication to family needs, and mediated conflict. Measurements and Main Results: Outcomes included depression, anxiety, and post-traumatic stress disorder (PTSD) among family 3 and 6 months after ICU and resource use. We identified 488 eligible patients and randomized 168. Of 352 eligible family members, 268 participated (76%). Family follow-up at 3 and 6 months ranged from 42 to 47%. The intervention was associated with decreased depressive symptoms at 6 months (P = 0.017), but there were no significant differences in psychological symptoms at 3 months or anxiety or PTSD at 6 months. The intervention was not associated with ICU mortality (25% control vs. 21% intervention; P = 0.615) but decreased ICU costs among all patients (per patient: $75,850 control, $51,060 intervention; P = 0.042) and particularly among decedents ($98,220 control, $22,690 intervention; P = 0.028). Among decedents, the intervention reduced ICU and hospital length of stay (28.5 vs. 7.7 d and 31.8 vs. 8.0 d, respectively; P ≤ 0.001). Conclusions: Communication facilitators may be associated with decreased family depressive symptoms at 6 months, but we found no significant difference at 3 months or in anxiety or PTSD. The intervention reduced costs and length of stay, especially among decedents. This is the first study to find a reduction in intensity of end-of-life care with similar or improved family distress.

Original languageEnglish (US)
Pages (from-to)154-162
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume193
Issue number2
DOIs
StatePublished - Jan 15 2016
Externally publishedYes

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Keywords

  • Communication
  • Critical care
  • Family
  • Palliative care
  • Randomized trial

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Curtis, J. R., Treece, P. D., Nielsen, E. L., Gold, J., Ciechanowski, P. S., Shannon, S., Khandelwal, N., Young, J. P., & Engelberg, R. A. (2016). Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. American Journal of Respiratory and Critical Care Medicine, 193(2), 154-162. https://doi.org/10.1164/rccm.201505-0900OC