Information Pamphlet Given to Relatives During the End-of-Life Decision in the ICU: An Assessor-Blinded, Randomized Controlled Trial

Abstract

Symptoms of posttraumatic stress disorder (PTSD) are common in family members of patients who have died in the ICU. Could a pamphlet describing the role of relatives in the end-of-life decision decrease their risk of developing PTSD-related symptoms? In this assessor-blinded, randomized controlled trial, 90 relatives of adult patients for whom an end-of-life decision was anticipated were enrolled. Relatives were randomly assigned to receive oral information as well as an information pamphlet explaining that the end-of-life decision is made by physicians (Group 1; n= 45) or oral information alone (Group 2; n= 45). PTSD-related symptoms were blindly assessed at 90days following the patient's death by using the Impact of Event Scale (scores range from 0 [indicating no symptoms] to 75 [indicating severe symptoms]). Anxiety and depression symptoms were assessed by using the Hospital Anxiety and Depression Scale score (range, 0-21 [higher scores indicate worse symptoms]). On day 90, the number of relatives with PTSD-related symptoms was significantly lower in Group 1 than in Group 2: 18 of 45 vs33 of 45 (P= .001). The risk ratio of having PTSD-related symptoms in Group 2 compared with Group 1 was 1.8 (95%CI, 1.2-2.7). The mean Impact of Event Scale and Hospital Anxiety and Depression Scale scores were significantly reduced in Group 1 compared with Group 2: 28 ± 10 vs38 ± 14 (P< .001) and 13 ± 5 vs17 ± 8 (P= .023), respectively. An information pamphlet describing the relatives' role during end-of-life decisions significantly reduced their risk of developing PTSD-related symptoms. ClinicalTrials.gov; No.: NCT02329418; URL: www.clinicaltrials.gov).