Helping Families of Terminal Patients

Many patients with critical illnesses can spend extended periods of time in the hospital, including intensive care units.  This is a difficult time for families of the patients, especially since many end up making care and treatment decisions for incapacitated patients.  Hospitals have attempted to find methods to help these families cope with the emotional burden they endure in these situations.   Research in the Journal of the American Medical Association reports on one such effort to help families of these critically ill patients.   (JAMA Article)   These family members often suffer from anxiety and depression and other health issues.  The researchers designed a program of informational and emotional support for the families, to be delivered by palliative care specialists, and looked at whether the program would reduce anxiety and depression among the family members.  The intervention was compared to usual care, which was not guided by palliative care specialists.  About 250 patients at 3 hospitals were involved in the study.  Anxiety and depression were measured by a commonly used interview scoring method.  The intervention meetings included discussions about the patient’s prognosis and about his or her goals and values related to health care, particularly when critically ill.  The intervention showed no improvement in the rate or extent of anxiety and depression among family members and those in the intervention group actually showed greater signs of post-traumatic stress syndrome.  There also was no difference in reporting on the adequacy of physician communication or in the perception that the patient’s preferences were understood and followed.  There also was no effect on length of stay, or use of other health care resources.  It may be that the usual care was actually pretty good in family communication, so differences would be hard to detect.  It also may be that there is little a hospital can do to lessen the stress families will feel in these circumstances.