Palliative Care-Led Support vs Usual Care: Not Significantly Different for Anxiety and Depression in Cancer Patients' Family Members

Palliative Care-Led Support vs Usual Care: Not Significantly Different for Anxiety and Depression in Cancer Patients' Family Members
Palliative Care-Led Support vs Usual Care: Not Significantly Different for Anxiety and Depression in Cancer Patients' Family Members

Palliative care–led informational and emotional support meetings do not reduce anxiety or depression symptoms and may increase posttraumatic stress disorder (PTSD) symptoms in family members of patients with chronic critical illness, a study presented in JAMA has shown.1

Family surrogate decision makers for patients with chronic critical illness experience significant psychological distress; therefore, these researchers sought to determine if meetings with palliative care clinicians could ease the distress family members experience.

This study involved adult patients (age 21 years or older) requiring 7 days of mechanical ventilation and their family surrogate decision makers from 4 medical intensive care units (ICUs). The multicenter trial was conducted from October 2010 through November 2014. Patients were randomized to an intervention group and a control group.

The intervention group (130 patients with 184 family surrogate decision makers) were engaged in at least 2 structured family meetings led by palliative care specialists and were given an informational brochure. The control group (126 patients with 181 family surrogate decision makers) was provided with an informational brochure and routine family meetings conducted by ICU teams.

Primary outcome was anxiety and depression, measured with the Hospital Anxiety and Depression Scale symptom score (HADS; score range 0 to 42; minimal clinically important difference, 1.5). Secondary outcomes were PTSD experienced by the family measured by the Impact of Events Scale-Revised (IES-R; total score range, 0 to 88), discussion of patient preferences, hospital length of stay, and 90-day survival. Outcomes measures were obtained at 3-month follow-up interviews with the surrogate decision makers.

The study was completed by 312 of 365 family surrogate decision makers (mean age, 51 years; 71% female). No significant difference in anxiety and depression symptoms were seen between the surrogate decision makers in the intervention group and those in the control group (adjusted mean HADS symptom score, 12.2 vs 11.4, respectively; between-group difference, 0.8 [95% CI, −0.9 to 2.6]; P =.34).

However, PTSD was greater in the intervention group compared with the control group (adjusted mean IES-R score, 25.9 vs 21.3, respectively; between-group difference, 4.60 [95% CI, 0.01 to 9.10]; P =.0495).

Secondary outcomes between the intervention and control groups included no significant difference regarding the discussion of patient preferences (75% vs 83%, respectively; odds ratio, 0.63 [95% CI, 0.34 to 1.16; P =.14]), median number of hospital days for patients (19 days vs 23 days, respectively; between-group difference, −4 days [95% CI, −6 to 3 days]; P = .51), and 90-day survival (hazard ratio, 0.95 [95% CI, 0.65 to 1.38], P =.96).

The researchers conclude that, compared with usual care, the use of palliative care–led informational and emotional support groups do not reduce anxiety or depression for families of patients with chronic critical illness and may increase PTSD symptoms. Furthermore, 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.

Reference

1. 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. doi: 10.1001/jama.2016.8474.

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