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“It Was the Only Thing I Could Hold Onto, But…”: Receiving a Letter of Condolence After Loss of a Loved One in the ICU A Qualitative Study of Bereaved Relatives’ Experience*

Kentish-Barnes, Nancy PhD1; Cohen-Solal, Zoé MS1; Souppart, Virginie RN1; Galon, Marion MS1; Champigneulle, Benoît MD2; Thirion, Marina MD3; Gilbert, Marion MD4; Lesieur, Olivier MD, PhD5; Renault, Anne MD6; Garrouste-Orgeas, Maïté MD, PhD7,8; Argaud, Laurent MD, PhD9; Venot, Marion MD10; Demoule, Alexandre MD, PhD11,12; Guisset, Olivier MD13; Vinatier, Isabelle MD14; Troché, Gilles MD15; Massot, Julien MD16; Jaber, Samir MD, PhD17; Bornstain, Caroline MD18; Gaday, Véronique MD19; Robert, René MD, PhD20; Rigaud, Jean-Philippe MD, PhD21; Cinotti, Raphaël MD22; Adda, Mélanie MD23; Thomas, François MS24; Azoulay, Elie MD, PhD1,25

doi: 10.1097/CCM.0000000000002687
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Objectives: Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members’ experience of receiving a letter of condolence.

Design: Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team. This study was designed to provide insight into the results of a larger randomized, controlled, multicenter study.

Setting: Twenty-two ICUs in France.

Subjects: Family members who lost a loved one in the ICU and who received a letter of condolence.

Measurements and Main Results: Thematic analysis was used and was based on 52 interviews and 26 letters. Six themes emerged: 1) a feeling of support, 2) humanization of the medical system, 3) an opportunity for reflection, 4) an opportunity to describe their loved one, 5) continuity and closure, and 6) doubts and ambivalence. Possible difficulties emerged, notably the re-experience of the trauma, highlighting the absence of further support.

Conclusions: This study describes the benefits of receiving a letter of condolence; mainly, it humanizes the medical institution (feeling of support, confirmation of the role played by the relative, supplemental information). However, this study also shows a common ambivalence about the letter of condolence’s benefit. Healthcare workers must strive to adapt bereavement follow-up to each individual situation.

Supplemental Digital Content is available in the text.

1Famiréa Research Group, Assistance Publique – Hôpitaux de Paris, Saint-Louis University Hospital, Paris, France.

2Medical Intensive Care Unit, Assistance Publique – Hôpitaux de Paris, Cochin University Hospital, Paris, France.

3Intensive Care Unit, Victor Dupouy Hospital, Argenteuil, France.

4Intensive Care Unit, Sud Francilien Hospital, Corbeil-Essonnes, France.

5Intensive Care Unit, La Rochelle Hospital, La Rochelle, France.

6Medical Intensive Care Unit, Cavale Blanche University Hospital, Brest, France.

7French British Institute Hospital, Levallois-Perret, France.

8Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.

9Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot Hospital and Lyon Est University, Lyon, France.

10Medical Intensive Care Unit, Assistance Publique – Hôpitaux de Paris, Saint-Louis University Hospital, Paris, France.

11Medical Intensive Care Unit, Assistance Publique – Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France.

12Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS1158, Paris, France.

13Medical Intensive Care Unit, Saint André University Hospital, Bordeaux, France.

14Intensive Care Unit, Les Oudairies Hospital, La Roche-sur-Yon, France.

15Intensive Care Unit, Versailles Hospital, Versailles, France.

16Cardio-surgical Intensive Care Unit, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.

17Surgical Intensive Care Unit, Saint Eloi University Hospital, and Inserm U-1046, Montpellier, France.

18Intensive Care Unit, Le Raincy-Montfermeil Hospital, Montfermeil, France.

19Intensive Care Unit, René-Dubos Hospital, Pontoise, France.

20Medical Intensive Care Unit, Poitiers University Hospital and Poitiers University and Inserm CIC 1402, Poitiers, France.

21Intensive Care Unit, Dieppe Hospital, Dieppe, France.

22Surgical Intensive Care Unit, Hôtel Dieu University Hospital, Nantes, France.

23Medical Intensive Care Unit, Assistance Publique – Hôpitaux de Marseille, Hôpital Nord University Hospital, Marseille, France.

24Medical Intensive Care Unit, Sud Amiens University Hospital, Amiens, France.

25Biostatistics and Clinical Epidemiology research (ECSTRA) team, U1153, INSERM, Paris Diderot Sorbonne University, Paris, France.

*See also p. 2099.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Fondation de France, a nonprofit institution.

ClinicalTrials.gov Identifier: NCT02325297

Dr. Kentish-Barnes’s institution received funding from Fondation de France. Dr. Demoule’s institution received funding from Fisher & Paykel and Philips; he has received funding from Medtronic, Covidien, Maquet, Resmed, Fisher & Paykel, and MSD; and he has signed research contracts with Covidien, Maquet, Fisher & Paykel, and Philips. Dr. Azoulay’s institution received funding and has supported research meetings in his hospital, from Fisher and Paykel, Gilead, Jazz Pharma, and Alexion, and he received funding from being a member of the board of Gilead Lectures for Alexion, Astellas, MSD, and Baxter. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information, regarding this article, E-mail: nancy.kentish@aphp.fr

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