Guiding intensive care physicians’ communication and behavior towards bereaved relatives: study protocol for a cluster randomized controlled trial (COSMIC-EOL)

Abstract Background Providing appropriate support and care for end-of-life patients and their relatives is a major concern and a daily responsibility for intensivists. Bereaved relatives of non-surviving patients in intensive care units (ICUs) often suffer from prolonged grief, posttraumatic stress disorder, anxiety, and depression. A physician-driven intervention, consisting of three meetings with the family, might reduce the post-ICU burden of bereaved family members 6 month after death. The patient’s nurse is actively involved at each step. We hypothesize that this strategy will improve communication in the end-of-life setting and thus, should reduce the post-ICU burden for family members, specifically the development of prolonged grief 6 months after the death. Methods/design The COSMIC-EOL trial is a prospective, multicenter, cluster randomized controlled trial in which centers are allocated to two parallel arms: (1) intervention centers where relatives benefit from three-step physician-driven support during the dying and death process and (2) control centers where, during the dying and death process, relatives receive the standard of care practice. Each of the 36 participating centers will include 25 relatives of patients with a length of stay ≥2 days. Participating relatives will be followed up by phone at 1, 3, and 6 months after the patient’s death to complete questionnaires permitting evaluation of their post-ICU burden. The main outcome is prolonged grief measured 6 months after the death using the PG-13. Other outcomes include evaluation of quality of dying, quality of communication, anxiety, depression, and post-traumatic stress. The estimated duration of the study is 36 months. Discussion The results of the trial will provide information about the effectiveness of physician-driven support for relatives of patients dying in an ICU. The study is expected to demonstrate a decrease in the ICU burden for bereaved relatives who benefitted from this intervention. Trial Registration ClinicalTrials.gov, NCT02955992. Registered on November 3rd 2016

Mort médicalisée et don d'organes : quelle perception pour les vivants ?

International audienceThe evocation of organ donation inevitably follows the brutal and unexpected intrusion of death into the psychic intimacy of the patient's loved ones. In the etymological sense of the word accompaniment "ad cum panem", caregivers will have to engage, with and for the deceased's relatives, in a meaningful effort of cognitive decoupling between their sensitive perception of death on the one hand and a decisive deliberation about organ donation on the other hand. Remote from events, it is instead the reconnecting of the two events that will give sense to the tragedy lived-a death that has meaning-and leads the grieving process on the way of resilience.L'évocation du don d'organe succède inévitablement à l'intrusion brutale, insolite et inattendue de la mort dans l'intimité psychique des vivants. Au sens étymologique du mot accompagnement « ad cum panem », les soignants vont devoir se livrer, avec et pour les proches du défunt, à un véritable travail de découplage cognitif entre leur perception sensible de la mort d'une part et une réflexion décisive sur le don d'organe d'autre part. A distance, c'est au contraire la reconnexion des deux évènements qui pourra donner un sens au drame vécu, celui d'une mort qui n'aura pas été vaine, et conduire le processus de deuil sur le chemin de la résilience

Mort médicalisée et don d'organes : quelle perception pour les vivants ?

International audienceThe evocation of organ donation inevitably follows the brutal and unexpected intrusion of death into the psychic intimacy of the patient's loved ones. In the etymological sense of the word accompaniment "ad cum panem", caregivers will have to engage, with and for the deceased's relatives, in a meaningful effort of cognitive decoupling between their sensitive perception of death on the one hand and a decisive deliberation about organ donation on the other hand. Remote from events, it is instead the reconnecting of the two events that will give sense to the tragedy lived-a death that has meaning-and leads the grieving process on the way of resilience.L'évocation du don d'organe succède inévitablement à l'intrusion brutale, insolite et inattendue de la mort dans l'intimité psychique des vivants. Au sens étymologique du mot accompagnement « ad cum panem », les soignants vont devoir se livrer, avec et pour les proches du défunt, à un véritable travail de découplage cognitif entre leur perception sensible de la mort d'une part et une réflexion décisive sur le don d'organe d'autre part. A distance, c'est au contraire la reconnexion des deux évènements qui pourra donner un sens au drame vécu, celui d'une mort qui n'aura pas été vaine, et conduire le processus de deuil sur le chemin de la résilience

Arrêt des traitements et idéologies thérapeutiques du cancer

Most cancer deaths in France occur in hospitals. Through in-depth interviews with 18 cancer physicians, we analyse their conceptions of ending cancer treatment and end of life care. All physicians point to specific difficulties with decision-making and team work. Two types of discourse appear granting different values to cancer treatment and end of life care. These two “therapeutic ideologies”, arising when cancer treatment is no longer useful, reveal different conceptions, no doubt crucial to medical practices and attitudes, about cancer trajectory and the role of physicians

Trouble de stress post-traumatique chez les survivants de réanimation et chez leurs proches : comprendre, prévenir, identifier et orienter

International audienceLes facteurs de stress lors d’un séjour en réanimation sont nombreux. S’interroger sur les conséquences de la maladie et des soins prodigués dans ces services en termes de qualité de vie, au-delà du simple devenir des malades en termes de mortalité est indispensable. Depuis une trentaine d'années, des études ont mesuré la prévalence des symptômes psychologiques des patients survivants et de leurs proches quelques mois après leur séjour en réanimation grâce à des échelles dédiées, et montrent qu’ils sont à haut risque de présenter un trouble de stress post-traumatique. Cet état fragilise ces personnes et altère considérablement et de manière quotidienne leur vie familiale, sociale et professionnelle. Il est possible de prévenir le TSPT, ou au moins d’en alléger la sévérité, en agissant à la fois sur la prise en charge médicale du patient, mais aussi sur la qualité de la communication avec le patient et ses proches : informations et accompagnement adaptés et personnalisés, soutien psychologique, organisation de la fin de vie

Arrêt des traitements et idéologies thérapeutiques du cancer

Most cancer deaths in France occur in hospitals. Through in-depth interviews with 18 cancer physicians, we analyse their conceptions of ending cancer treatment and end of life care. All physicians point to specific difficulties with decision-making and team work. Two types of discourse appear granting different values to cancer treatment and end of life care. These two “therapeutic ideologies”, arising when cancer treatment is no longer useful, reveal different conceptions, no doubt crucial to medical practices and attitudes, about cancer trajectory and the role of physicians

Qualitative research: adding drive and dimension to clinical research.

International audienceQualitative research and its methods stem from the social sciences and can be used to describe and interpret complex phenomena that involve individuals' views, beliefs, preferences, and subjective responses to places and people. Thus, qualitative research explores the many subjective factors that may influence patient outcomes, staff well-being, and healthcare quality, yet fail to lend themselves to the hypothesis-testing approach that characterizes quantitative research. Qualitative research is valuable in the intensive care unit to explore organizational and cultural issues and to gain insight into social interactions, healthcare delivery processes, and communication. Qualitative research generates explanatory models and theories, which can then serve to devise interventions, whose efficacy can be studied quantitatively. Thus, qualitative research works synergistically with quantitative research, providing new impetus to the research process and a new dimension to research findings. Qualitative research starts with conceptualizing the research question, choosing the appropriate qualitative strategy, and designing the study; rigorous methods specifically designed for qualitative research are then used to conduct the study, analyze the data, and verify the findings. The researcher is the data-collecting instrument, and the data are the participants' words and behaviors. Data coding methods are used to describe experiences, discover themes, and build theories. In this review, we outline the rationale and methods for conducting qualitative research to inform critical care issues. We provide an overview of available qualitative methods and explain how they can work in close synergy with quantitative methods. To illustrate the effectiveness of combining different research methods, we will refer to recent qualitative studies conducted in the intensive care unit

Additional file 2: of Impact of the condolence letter on the experience of bereaved families after a death in intensive care: study protocol for a randomized controlled trial

Recommendations for writing a condolence letter and examples. (DOCX 22 kb