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Garrouste-Orgeas M, Marché V, Pujol N, Michel D, Evin A, Fossez-Diaz V, Perruchio S, Vanbésien A, Verlaine C, Copel L, Kaczmarek W, Birkui de Francqueville L, Michonneau-Gandon V, de Larivière E, Poupardin C, Touzet L, Guastella V, Mathias C, Mhalla A, Bouquet G, Richard B, Gracia D, Bienfait F, Verliac V, Ranchou G, Kirsch S, Flahault C, Loiodice A, Bailly S, Ruckly S, Timsit JF. Incidence and risk factors of prolonged grief in relatives of patients with terminal cancer in French palliative care units: The Fami-Life multicenter cohort study. Palliat Support Care 2023:1-10. [PMID: 36878669 DOI: 10.1017/s1478951523000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Psychological consequences of grief among relatives are insufficiently known. We reported incidence of prolonged grief among relatives of deceased patients with cancer. METHODS Prospective cohort study of 611 relatives of 531 patients with cancer hospitalized for more than 72 hours and who died in 26 palliative care units was conducted. The primary outcome was prolonged grief in relatives 6 months after patient death, measured with the Inventory Complicated Grief (ICG > 25, range 0-76, a higher score indicates more severe symptoms) score. Secondary outcomes in relatives 6 months after patient death were anxiety and depression symptoms based on Hospital Anxiety and Depression Scale (HADS) score (range 0 [best]-42 [worst]), higher scores indicate more severe symptoms, minimally important difference 2.5. Post-traumatic stress disorder symptoms were defined by an Impact Event Scale-Revised score >22 (range 0-88, a higher score indicates more severe symptoms). RESULTS Among 611 included relatives, 608 (99.5%) completed the trial. At 6 months, significant ICG scores were reported by 32.7% relatives (199/608, 95% CI, 29.0-36.4). The median (interquartile range ICG score) was 20.0 (11.5-29.0). The incidence of HADS symptoms was 87.5% (95% CI, 84.8-90.2%) at Days 3-5 and 68.7% (95% CI, 65.0-72.4) 6 months after patient's death, with a median (interquartile range) difference of -4 (-10 to 0) between these 2 time points. Improvement in HADS anxiety and depression scores were reported by 62.5% (362/579) relatives. SIGNIFICANCE OF RESULTS These findings support the importance of screening relatives having risk factors of developing prolonged grief in the palliative unit and 6 months after patient's death.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, INSERM, Université de Paris, Paris, France
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
- Medical Unit, French British Hospital, Levallois-Perret, France
| | | | - Nicolas Pujol
- Research Department Palliative Care Unit, Jeanne Garnier Institution, Paris, France
| | - Dominique Michel
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care Unit, University Teaching Hospital, Nantes, France
| | | | | | | | | | - Laure Copel
- Palliative Care Unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | | | | | | | | | | | - Licia Touzet
- Palliative Care Unit, University Teaching Hospital, Lille, France
| | - Virginie Guastella
- Palliative Care Unit, University Teaching Hospital, Clermont Ferrand, France
| | - Carmen Mathias
- Palliative Care Unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Alaa Mhalla
- Palliative Care Unit, Albert Chenevier Hospital, Créteil, France
| | | | - Bruno Richard
- Palliative Care Unit, University Teaching Hospital, Montpellier, France
| | - Dominique Gracia
- Palliative Care Unit, General Hospital, Salon-de-Provence, France
| | - Florent Bienfait
- Palliative Care Unit, University Teaching Hospital, Angers, France
| | - Virginie Verliac
- Palliative Care Unit, Saintonge General Hospital, Saintes, France
| | - Gaelle Ranchou
- Palliative Care Unit, General Hospital, Périgueux, France
| | - Sylvie Kirsch
- Palliative Care Unit, Bligny Hospital, Briis-Sous-Forges, France
| | - Cécile Flahault
- Laboratory of Psychopathology and Health Process, Paris University Paris, Boulogne-Billancourt, France
| | | | | | | | - Jean-François Timsit
- IAME, INSERM, Université de Paris, Paris, France
- Medical and infectious diseases ICU (MI2), APHP Bichat Hospital, Paris, France
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Garrouste-Orgeas M, Flahault C, Poulain E, Evin A, Guirimand F, Fossez-Diaz V, Perruchio S, Verlaine C, Vanbésien A, Kaczmarek W, Birkui de Francqueville L, De Larivière E, Bouquet G, Copel L, Verliac V, Marché V, Mathias C, Gracia D, Mhalla A, Michonneau-Gandon V, Poupardin C, Touzet L, Ranchou G, Guastella V, Richard B, Bienfait F, Sonrier M, Michel D, Ruckly S, Bailly S, Timsit JF. The Fami-life study: protocol of a prospective observational multicenter mixed study of psychological consequences of grieving relatives in French palliative care units on behalf of the family research in palliative care (F.R.I.P.C research network). BMC Palliat Care 2019; 18:111. [PMID: 31818281 PMCID: PMC6902332 DOI: 10.1186/s12904-019-0496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background Grieving relatives can suffer from numerous consequences like anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and prolonged grief. This study aims to assess the psychological consequences of grieving relatives after patients’ death in French palliative care units and their needs for support. Methods This is a prospective observational multicenter mixed study. Relatives of adult patients with a neoplasia expected to be hospitalized more than 72 h in a palliative care unit for end-of-life issues will be included within 48 h after patient admission. End-of-life issues are defined by the physician at patient admission. Relatives who are not able to have a phone call at 6-months are excluded. The primary outcome is the incidence of prolonged grief reaction defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at 6 months after patient’ death. Prespecified secondary outcomes are the risk factors of prolonged grief, anxiety and depression symptoms between day 3 and day 5 and at 6 months after patients’ death based on an Hospital Anxiety and Depression score (range 0–42) > 8 for each subscale (minimal clinically important difference: 2.5), post-traumatic stress disorder symptoms 6 months after patient’ death based on the Impact of Events Scale questionnaire (0 best-88 worst) score > 22, experience of relatives during palliative care based on the Fami-Life questionnaire, specifically built for the study. Between 6 and 12 months after the patient’s death, a phone interview with relatives with prolonged grief reactions will be planned by a psychologist to understand the complex system of grief. It will be analyzed with the Interpretative Phenomenological Analysis. We planned to enroll 500 patients and their close relatives assuming a 25% prolonged grief rate and a 6-month follow-up available in 60% of relatives. Discussion This study will be the first to report the psychological consequences of French relatives after a loss of a loved one in palliative care units. Evaluating relatives’ experiences can provide instrumental insights for means of improving support for relatives and evaluation of bereavement programs. Trial registration NCT03748225 registered on 11/19/2018. Recruiting patients.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, INSERM, Université de Paris, F-75018, Paris, France. .,Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France. .,Medical unit, French British Hospital, Levallois-Perret, France. .,Service de médecine interne, Hôpital Franco Britannique, 4 rue Kléber, 92 300, Levallois-Perret, France.
| | - Cécile Flahault
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Edith Poulain
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care unit, University Teaching Hospital, Nantes, France
| | - Frédéric Guirimand
- Palliative Care unit, Jeanne Garnier Institution, Paris, France.,UFR Simone VEIL - Santé, Versailles Saint Quentin en Yvelines University, Versailles, France
| | | | | | | | | | | | | | | | | | - Laure Copel
- Palliative Care unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Virginie Verliac
- Palliative Care unit, Saintonge General Hospital, Saintes, France
| | | | - Carmen Mathias
- Palliative Care unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Dominique Gracia
- Palliative Care unit, General Hospital, Salon-de-Provence, France
| | - Alaa Mhalla
- Palliative Care unit, Albert Chenevier Hospital, Créteil, France
| | | | | | - Licia Touzet
- Palliative Care unit, University Teaching Hospital, Lille, France
| | - Gaelle Ranchou
- Palliative Care unit, General Hospital, Périgueux, France
| | - Virginie Guastella
- Palliative Care unit, University Teaching Hospital, Clermont Ferrand, France
| | - Bruno Richard
- Palliative Care unit, University Teaching Hospital, Montpellier, France
| | - Florent Bienfait
- Palliative Care unit, University Teaching Hospital, Angers, France
| | - Marie Sonrier
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Dominique Michel
- Palliative Care unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | | | - Sébastien Bailly
- INSERM, CHU Grenoble Alpes, Grenoble Alpes University, HP2, Grenoble, France
| | - Jean-François Timsit
- IAME, INSERM, Université de Paris, F-75018, Paris, France.,AP-HP, Bichat Hospital, Medical and infectious diseases ICU (MI2), F-75018, Paris, France
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