LAUSR

Dear Editor, Prigerson and Jacobs [1] highlighted the importance of maintaining a link between caregivers and families during the bereavement process. Therefore, a condolence letter to the family of patients who die in the intensive care unit (ICU) may alleviate grief symptoms. Surprisingly, although this letter was perceived positively by families, it was found to increase symptoms of depression at 6 months [2]. Our pilot study evaluated the benefits of a post-death meeting (PDM) for the families of patients who died at least two days after ICU admission, in a mixed ICU in a non-academic hospital in France, and was previously reported at the congress of the French Intensive Care Society [3]. During the patient’s stay, family presence was allowed 24/7, a formal meeting was held between staff and families, and they could meet a psychologist on demand. Two weeks after the patient’s death, the psychologist called the family to offer emotional support and to invite them to a PDM with the psychologist and physician. The meeting was scheduled three to four weeks after the patient’s death and aimed to provide emotional support, answer medical questions, and detect symptoms of anxiety/depression using the Hospital Anxiety and Depression Scale (HADS) [4]. Relatives completed the HADS just before the meeting, and three months afterwards. We planned to enroll 70 relatives. Among 53 relatives (one per family), 45 (84%) answered the phone call, and only 12 (23%) accepted to attend the PDM, prompting premature discontinuation of the study before enrolment was complete. Eleven relatives had a HADS anxiety score ≥ 8, while 10 had a HADS depression score ≥ 8 out of 12 relatives. The bereavement program was well perceived in 86% of cases. The main topics raised by relatives concerned the emotional aspects of grief, while only 41% had medical questions. By univariate analysis, acceptance of the PDM was associated with a shorter duration of ICU stay (4.3 days vs 7.3 days, p = 0.027) (Table 1). The unexpectedly low rate of PDM acceptance may be in part, because the phone call offers emotional support and may satisfy most families. Among the 33 relatives who declined the PDM, 14 expressed gratitude for the phone call, and 13 reported they felt no need for the PDM. This could explain the high prevalence of anxiety/ depression symptoms in the relatives who accepted the PDM, given that they likely represent the most severely affected relatives, with high emotional support needs. This low rate of PDM acceptance may also be explained by the selection of patients who died not unexpectedly after at least two days. The low rate of medical questions is at variance with the experience of Kock et al. [5], where 91% of relatives had medical questions. However, Kock’s study focused on unexpected early death, whereas these patients were excluded from our study. Overall, we hypothesize that a phone call might be a first step to offering emotional support, personalizing the bereavement program, and identifying needs for the PDM. The low rate of PDM acceptance (23%) might be improved in families experiencing early unexpected death.