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Families of the dying benefit from longer talks with doctors

Doctors can make a patient's death less traumatic for family members by providing more information and holding longer, more structured meetings with them, according to a study in the New England Journal of Medicine today.

Doctors in intensive-care units, which treat the sickest patients, meet with families when they learn a patient is going to die. These meetings, common in the US and Europe, have no specific structure, and families can leave confused about the patient's diagnosis, said Elie Azoulay, who led the study at 22 French hospitals. Families in the study met with doctors for about 30 minutes, 10 minutes longer than typical, giving them more time to express concerns.
Doctors gave families a booklet that reiterated the patient was going to die and provided advice on funeral arrangements, symptoms of grief and places to go for emotional support. „It's not something that is improvised, it's something that is organized,” said Azoulay, a doctor at the Saint-Louis Hospital in Paris. „They had more time to speak and to express their emotions. They had more opportunities to express concerns.”
Sixty-three people were given the more intensive meeting and 63 more got the standard meeting. Researchers who called families 90 days after the patient's death found 29% of the intensive-meeting group showed signs of depression compared with 56% of the standard group. 45% of those in the longer meeting showed symptoms of anxiety, compared with 67% of those in the shorter conference. By 2030, almost one in five Americans, 72 million people, will be 65 years or older, according to the National Institute on Aging. The fastest growing segment is 85 years and older.

Emphasizing that a loved one won't get better decreases anxiety in the long run, Azoulay said. „I'm sure that talking to the families and reporting to them everything empowers them,” Azoulay said. Family members who initially disagreed with the decision to withdraw life support or stop treatment were also more likely to agree with doctors after the meeting, the study said.
The people closest to the patient said they felt more support in making difficult decisions and experienced less guilt, the study said. „We have to negotiate with the families,” Azoulay said. „When we are implementing our communication strategy, it is easier to explain to the family that treatment is futile.” The study was paid for by grants from Assistance Publique-Hopitaux de Paris and the French Society for Critical Care Medicine. Azoulay has received grant support from Pfizer Inc. (Bloomberg)