Palliative care · Supporting families
Palliative Care-Led Meetings for Families of Patients With Chronic Critical Illness
| Design | Multicentre randomised clinical trial |
|---|---|
| Treatment | Structured family meetings led by palliative care specialists |
| Control | Usual care family meetings |
| Population | 365 family surrogate decision makers, mean age 51, 71% female; 312 completed the study |
| Follow-up | 3 months |
| Primary endpoint | Anxiety and depression symptoms on the Hospital Anxiety and Depression Scale at 3 months |
| Result | At 3 months there was no significant difference in anxiety and depression symptoms between the groups, and post-traumatic stress symptoms were higher in the intervention group. |
| Secondary endpoints | Post-traumatic stress symptoms, discussion of prognosis, length of stay, mortality |
Among families of patients with chronic critical illness, the use of palliative care-led informational and emotional support meetings compared with usual care did not reduce anxiety or depression symptoms and may have increased posttraumatic stress disorder symptoms. These findings do not support routine or mandatory palliative care-led discussion of goals of care for all families of patients with chronic critical illness.
The trial authors, in the published abstract
An uncomfortable and important result: structured prognostic discussion, delivered by specialists who did not know the family, appears to have harmed rather than helped. Read with PARTNER, where the same support delivered by the treating team did better on communication — continuity may be the active ingredient.
Carson SS, Cox CE, Wallenstein S, et al. Effect of Palliative Care-Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial. JAMA 2016 Jul 5;316(1):51-62.