Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Jan 15;193(2):154-62.
doi: 10.1164/rccm.201505-0900OC.

Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care

J Randall Curtis  1   2 , Patsy D Treece  1 , Elizabeth L Nielsen  1 , Julia Gold  3 , Paul S Ciechanowski  4 , Sarah E Shannon  2 , Nita Khandelwal  5 , Jessica P Young  1 , Ruth A Engelberg  1
Affiliations
Randomized Controlled Trial

Randomized Trial of Communication Facilitators to Reduce Family Distress and Intensity of End-of-Life Care

J Randall Curtis et al. Am J Respir Crit Care Med. .

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. Clinical trial registered with www.clinicaltrials.gov (NCT 00720200).

Trial registration: ClinicalTrials.gov NCT00720200.

Keywords: communication; critical care; family; palliative care; randomized trial.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow diagram of patient and family sample development. *Baseline data were too late if the questionnaire was completed more than 14 days after distribution; follow-up data were too late if the questionnaire was completed more than 60 days after distribution. LNOK = legal next of kin.
Figure 2.
Figure 2.
Proportion of family members with a minimal clinically important change in symptoms of depression between baseline and 3- or 6-month follow-up.
See this image and copyright information in PMC

Comment in

References

    1. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD Robert Wood Johnson Foundation ICU End-Of-Life Peer Group. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32:638–643. - PubMed
    1. Hough CL, Curtis JR. Long-term sequelae of critical illness: memories and health-related quality of life. Crit Care. 2005;9:145–146. - PMC - PubMed
    1. Heyland DK, Hopman W, Coo H, Tranmer J, McColl MA. Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life. Crit Care Med. 2000;28:3599–3605. - PubMed
    1. Curtis JR, Vincent JL. Ethics and end-of-life care for adults in the intensive care unit. Lancet. 2010;376:1347–1353. - PubMed
    1. Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, Briggs KB, Komatsu GI, Goodman-Crews P, Cohn F, et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA. 2003;290:1166–1172. - PubMed

Publication types

MeSH terms

Associated data