Complicated grief after death of a relative in the intensive care unit
Complicated grief after death of a relative in the intensive care unit
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DOI：
10.1183/09031936.00160014
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发表时间：
2015-05-01
影响因子：
24.3
通讯作者：
Azoulay, Elie
中科院分区：
文献类型：
--
作者：
Kentish-Barnes, Nancy;Chaize, Marine;Azoulay, Elie
在重症监护病房（ICU）发生的死亡比例增加。我们在41个ICU中进行了这项前瞻性研究，以确定ICU中亲人死亡后复杂悲伤的患病率和决定因素。对475名成年患者的亲属进行了随访。在6个月和12个月时使用复杂悲伤量表评估复杂悲伤（截止分数bbb25）。亲属也在3个月时完成医院焦虑和抑郁量表，并在3、6和12个月时完成创伤后应激障碍症状的修订事件影响量表。我们使用混合多元逻辑回归模型来确定6个月后复杂悲伤的决定因素。475例患者中，282例（59.4%）在6个月时进行了相关评估。147名（52%）亲属发现了复杂的悲伤症状。复杂悲伤症状的独立决定因素要么是无法改变的（女性亲属、独居亲属和2009年之前的重症监护医师委员会认证），要么是可能改善的目标（患者拒绝治疗、患者在插管时死亡、死亡时亲属在场、亲属未与患者道别、医生与亲属之间沟通不良）。临终实践、沟通和失去亲人的孤独感可能会得到改善。
An increased proportion of deaths occur in the intensive care unit (ICU).We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score >25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months.Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives).End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.