Communication with bereaved family members after death in the ICU: the CATHARTIC randomised clinical trial

Laurie Showler; Louise Rait; Michael Chan; Mark Tondello; Alastair George; Brianna Tascone; Jeffrey J Presneill; Christopher M MacIsaac; Yasmine Ali Abdelhamid; Adam M Deane

doi:10.51893/2022.2.OA2

Communication with bereaved family members after death in the ICU: the CATHARTIC randomised clinical trial

Crit Care Resusc. 2023 Oct 19;24(2):116-127. doi: 10.51893/2022.2.OA2. eCollection 2022 Jun 6.

Authors

Laurie Showler¹, Louise Rait¹, Michael Chan², Mark Tondello¹, Alastair George¹, Brianna Tascone¹, Jeffrey J Presneill^{1

3}, Christopher M MacIsaac^{1

3}, Yasmine Ali Abdelhamid^{1

3}, Adam M Deane^{1

3}

Affiliations

¹ Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia.
² Department of Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.
³ Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.

Abstract

Objective: It is uncertain whether psychological distress in the family members of patients who die during an intensive care unit (ICU) admission may be improved by bereavement interventions. In this trial, relatives' symptoms of anxiety and depression after 6 months were measured when allocated to three commonly used bereavement follow-up strategies. Design: Single-centre, randomised, three parallel-group trial. Setting: A tertiary ICU in Australia. Participants: Relatives of patients who died in the ICU. Interventions: Relatives received bereavement follow-up 4 weeks after the death using a condolence letter, short telephone call or no contact. Main outcome measures: The primary outcome was the total Hospital Anxiety and Depression Scale (HADS-T) score. Secondary outcomes estimated anxiety, depression, complicated grief, post-traumatic stress, and satisfaction with ICU care. Results: Seventy-one relatives participated (24 had no contact, 19 were contacted by letter and 28 by telephone 4 weeks after the death). The mean HADS-T score for no contact was 16.1 (95% CI, 12.4-19.8). Receipt of a letter was associated with a mean HADS-T increase of 1.4 (4.0 decrease to 6.8 increase), and a condolence call was accompanied by a mean decrease of 1.6 (6.6 decrease to 3.4 increase; P > 0.5). Non-significant differences were observed for all secondary outcomes. Conclusions: Anxiety and depression at 6 months in the relatives of patients who died in the ICU was not meaningfully alleviated by receipt of either a condolence letter or telephone call. Trial registration: Australia New Zealand Clinical Trials Registry (ACTRN12619000917134).