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 E. Shannon, Nita Khandelwal, Jessica P. Young, Ruth A. Engelberg

Research output: Contribution to journalArticle

  • 47 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.

LanguageEnglish (US)
Pages154-162
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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Terminal Care
Communication
Intensive Care Units
Post-Traumatic Stress Disorders
Length of Stay
Anxiety
Depression
Costs and Cost Analysis
Mortality
Critical Illness
Psychology

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

Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. / Curtis, J. Randall; Treece, Patsy D.; Nielsen, Elizabeth L.; Gold, Julia; Ciechanowski, Paul S.; Shannon, Sarah E.; Khandelwal, Nita; Young, Jessica P.; Engelberg, Ruth A.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 193, No. 2, 15.01.2016, p. 154-162.

Research output: Contribution to journalArticle

Curtis, JR, Treece, PD, Nielsen, EL, Gold, J, Ciechanowski, PS, Shannon, SE, Khandelwal, N, Young, JP & Engelberg, RA 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, vol. 193, no. 2, pp. 154-162. DOI: 10.1164/rccm.201505-0900OC
Curtis, J. Randall ; Treece, Patsy D. ; Nielsen, Elizabeth L. ; Gold, Julia ; Ciechanowski, Paul S. ; Shannon, Sarah E. ; Khandelwal, Nita ; Young, Jessica P. ; Engelberg, Ruth A./ Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. In: American Journal of Respiratory and Critical Care Medicine. 2016 ; Vol. 193, No. 2. pp. 154-162
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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.",
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