Palliative care-led informational and emotional support meetings with families of ICU patients did not reduce anxiety or depression symptoms, and may have increased post-traumatic stress disorder symptoms, found a recent study.1

“We had hypothesized that structured meetings with families of patients in the ICU about prognosis and treatment options would reduce anxiety and depression,” says James A. Tulsky, MD, one of the study’s authors. Tulsky is chair of the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, and professor of medicine at Harvard Medical School.

Instead, the researchers found no difference between the intervention and the control group. In fact, family members receiving the intervention were more likely to experience long-term negative outcomes. Tulsky theorizes this is perhaps because families experienced the trauma of receiving bad news about potential outcomes, without ongoing emotional support.

“We recognize that these were not true palliative care consultations, and that many important elements of such care were missing,” notes Tulsky. The primary difference was that there was no longitudinal follow-up, and the families were not really treated as the responsibility of the palliative care clinicians.

“The clinicians leading these meetings never had an opportunity to develop real relationships with the families, and follow up with them over time to help them process the experience,” Tulsky explains.

The study’s findings do not support routine or mandatory palliative care-led discussion of goals of care for all families of patients with chronic critical illness. “This study and other reports remind us that information given in serious illness can be damaging, if not done under the appropriate circumstances,” Tulsky says.2 “Disclosing prognosis outside of the context of a therapeutic relationship risks creating harm.” The study left the researchers wondering which aspects of palliative care make the greatest difference.

“We need to think carefully about palliative care or ethics interventions that don’t allow for longitudinal care,” Tulsky concludes.

REFERENCE

  1. Carson SS, Cox CE, Wallenstein, et al. Effect of palliative care-led meetings for families of patients with chronic critical illness: A randomized clinical trial. JAMA 2016; 316(1):51-62.
  2. Rose S, Bisson J, Churchill R, et al. Psychological debriefing for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2002; (2):CD000560.

SOURCE

  • James A. Tulsky, MD, Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston. Phone: (617) 582-9201. Fax: (617) 632-6180. Email: jamesa_tulsky@dfci.harvard.edu.