Just 3️⃣simple acts of compassion can go a long way
Important RCT just published in @TheLancet shows that a family support strategy consisting of 3 extra family meetings can substantially reduce family grief 6mo after the death of a loved one in the ICU
thelancet.com/journals/lance…
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Important RCT just published in @TheLancet shows that a family support strategy consisting of 3 extra family meetings can substantially reduce family grief 6mo after the death of a loved one in the ICU
thelancet.com/journals/lance…
1/
Pre-pandemic, ICU mortality was often ~20%
In the US, 30-60% of ICU deaths were preceded by a decision to withdraw life support
We are experts at providing comfort focused care for patients but in many cases, families feel grief months afterwards
What can we do about this?
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In the US, 30-60% of ICU deaths were preceded by a decision to withdraw life support
We are experts at providing comfort focused care for patients but in many cases, families feel grief months afterwards
What can we do about this?
2/
The COSMIC RCT studied this.
The intervention was 3 family meetings held following a decision to withdraw life support:
1️⃣family conference to prepare relatives for the imminent death
2️⃣ICU-room visit to provide support
3️⃣meeting after death to offer condolences & closure
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The intervention was 3 family meetings held following a decision to withdraw life support:
1️⃣family conference to prepare relatives for the imminent death
2️⃣ICU-room visit to provide support
3️⃣meeting after death to offer condolences & closure
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COSMIC was done at 34 🇫🇷ICUs
Between 2017-2019, they enrolled n=484 relatives of ICU patients to the intervention group & n=391 to the control group. ICUs were cluster randomized to the 3 part intervention case SOC.
Most (78-79%) completed the 6-month telephone interview.
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Between 2017-2019, they enrolled n=484 relatives of ICU patients to the intervention group & n=391 to the control group. ICUs were cluster randomized to the 3 part intervention case SOC.
Most (78-79%) completed the 6-month telephone interview.
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The effect was pretty impressive:
The median PG-13 score (an instrument used to measure grief, not movie ratings) was lower in the intervention group: 19 vs 21
More importantly, it reduced the number of relatives with prolonged grief symptoms: 57 (15%) vs 66 (21%)
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The median PG-13 score (an instrument used to measure grief, not movie ratings) was lower in the intervention group: 19 vs 21
More importantly, it reduced the number of relatives with prolonged grief symptoms: 57 (15%) vs 66 (21%)
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So why tweet this? Because it will change my practice!
Pre-pandemic, I always meet with families *before* transitioning to comfort. I often informally talked to relatives afterwards. I didn’t always meet at the bedside (thinking I was giving them “space”)
COSMIC changes that.
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Pre-pandemic, I always meet with families *before* transitioning to comfort. I often informally talked to relatives afterwards. I didn’t always meet at the bedside (thinking I was giving them “space”)
COSMIC changes that.
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The combination of a large effect size (NNT 4 to prevent one person from having severe persistent grief) & being fairly easy to implement (hold two more family meetings), makes this the ideal trial to change my practice in the ICU.
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