法国巴黎圣路易斯医院Nancy Kentish-Barnes团队研究了三步支持策略对重症监护病房死亡患者亲属的影响。这一研究成果发表在2022年1月19日出版的《柳叶刀》杂志上。

在重症监护病房（ICU）死亡患者的亲属中，团队支持不足会增加长期悲伤和其他心理伤害的发生率。该研究旨在评估主动沟通和支持干预是否会改善亲属的状况。

研究组在法国的34个ICU中开展了一项前瞻性、多中心、整群随机对照试验，比较标准护理和医生驱动、护士辅助的三步支持策略在决定退出或停止生命支持后的整个死亡过程中的家庭成员的支持效果。

纳入标准为18岁以上、ICU住院2天以上患者的亲属。参与ICU的患者被随机分为干预组和对照组。随机化方案由一名未参与本研究的统计学家生成。干预组与亲属举行了三次会议：一次家庭会议，让亲属为即将到来的死亡做好准备；一次ICU病房探访，以提供积极的支持；一次在患者死亡后召开会议，表示哀悼和结束。

对照组采用最佳护理标准，与病危患者亲属进行沟通和支持。主要终点是患者死亡6个月后持续悲伤的亲属比例（用PG-13测量，评分≥30）。分析采用意向治疗法，以丧失亲人为观察个体。

2017年2月23日至2019年10月8日，研究组将484名ICU患者纳入干预组，391名纳入对照组。干预组中有379名（78%）亲属完成了6个月的随访，以评估主要终点，对照组中有309名（79%）。干预组中57名（15%）亲属有长期悲伤症状，显著低于对照组的66名（21%）；干预组中位PG-13评分为19分，显著低于对照组的21分。

研究结果表明，对于ICU死亡患者的亲属，医生驱动、护士辅助的三步支持策略显著减少了长期悲伤症状。

附：英文原文

Title: A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial

Author: Nancy Kentish-Barnes, Sylvie Chevret, Sandrine Valade, Samir Jaber, Lionel Kerhuel, Olivier Guisset, Malle Martin, Amélie Mazaud, Laurent Papazian, Laurent Argaud, Alexandre Demoule, David Schnell, Eddy Lebas, Frédéric Ethuin, Emmanuelle Hammad, Sybille Merceron, Juliette Audibert, Clarisse Blayau, Pierre-Yves Delannoy, Alexandre Lautrette, Olivier Lesieur, Anne Renault, Danielle Reuter, Nicolas Terzi, Bénédicte Philippon-Jouve, Maud Fiancette, Michel Ramakers, Jean-Philippe Rigaud, Virginie Souppart, Karim Asehnoune, Benot Champigneulle, Dany Goldgran-Toledano, Jean-Louis Dubost, Pierre-Edouard Bollaert, Renaud Chouquer, Frédéric Pochard, Alain Cariou, Elie Azoulay

Issue&Volume: 2022-01-19

Abstract:

Background

In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes.

Methods

We undertook a prospective, multicentre, cluster randomised controlled trial in 34 ICUs in France, to compare standard care with a physician-driven, nurse-aided, three-step support strategy for families throughout the dying process, following a decision to withdraw or withhold life support. Inclusion criteria were relatives of patients older than 18 years with an ICU length of stay 2 days or longer. Participating ICUs were randomly assigned (1:1 ratio) into an intervention cluster and a control cluster. The randomisation scheme was generated centrally by a statistician not otherwise involved in the study, using permutation blocks of non-released size. In the intervention group, three meetings were held with relatives: a family conference to prepare the relatives for the imminent death, an ICU-room visit to provide active support, and a meeting after the patient's death to offer condolences and closure. ICUs randomly assigned to the control group applied their best standard of care in terms of support and communication with relatives of dying patients. The primary endpoint was the proportion of relatives with prolonged grief (measured with PG-13, score ≥30) 6 months after the death. Analysis was by intention to treat, with the bereaved relatives as the unit of observation. The study is registered with ClinicalTrials.gov, NCT02955992.

Findings

Between Feb 23, 2017, and Oct 8, 2019, we enrolled 484 relatives of ICU patients to the intervention group and 391 to the control group. 379 (78%) relatives in the intervention group and 309 (79%) in the control group completed the 6-month interview to measure the primary endpoint. The intervention significantly reduced the number of relatives with prolonged grief symptoms (66 [21%] vs 57 [15%]; p=0·035) and the median PG-13 score was significantly lower in the intervention group than in the control group (19 [IQR 14–26] vs 21 [15–29], mean difference 2·5, 95% CI 1·04–3·95).

Interpretation

Among relatives of patients dying in the ICU, a physician-driven, nurse-aided, three-step support strategy significantly reduced prolonged grief symptoms.

DOI: 10.1016/S0140-6736(21)02176-0

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02176-0/fulltext