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
. 2017 Apr;43(4):473-484.
doi: 10.1007/s00134-016-4669-9. Epub 2017 Feb 14.

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 , Benoît Champigneulle  3 , Marina Thirion  4 , Virginie Souppart  1 , Marion Gilbert  5 , Olivier Lesieur  6 , Anne Renault  7 , Maïté Garrouste-Orgeas  8 , Laurent Argaud  9 , Marion Venot  10 , Alexandre Demoule  11 , Olivier Guisset  12 , Isabelle Vinatier  13 , Gilles Troché  14 , Julien Massot  15 , Samir Jaber  16 , Caroline Bornstain  17 , Véronique Gaday  18 , René Robert  19 , Jean-Philippe Rigaud  20 , Raphaël Cinotti  21 , Mélanie Adda  22 , François Thomas  23 , Laure Calvet  24 , Marion Galon  1 , Zoé Cohen-Solal  1 , Alain Cariou  25 , Elie Azoulay  26   27 ; Famirea Study Group
Affiliations
Randomized Controlled Trial

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

Nancy Kentish-Barnes et al. Intensive Care Med. 2017 Apr.

Abstract

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.

Keywords: Bereaved relatives; Grief symptoms; Letter of condolence.

PubMed Disclaimer

References

    1. J Chronic Dis. 1986;39(9):735-42 - PubMed
    1. Am J Respir Crit Care Med. 2005 May 1;171(9):987-94 - PubMed
    1. Ann Intensive Care. 2014 Nov 30;4:37 - PubMed
    1. Intensive Care Med. 2015 Oct;41(10):1763-72 - PubMed
    1. J Oncol Pract. 2012 Sep;8(5):275-81 - PubMed

Publication types

MeSH terms

Associated data