The use of palliative care-led informational and emotional support meetings compared with usual care did not reduce anxiety or depression symptoms and may have increased posttraumatic stress disorder (PTSD) symptoms among families of patients with chronic critical illness. This according to a randomized clinical trial conducted from October 2010 through November 2014 in 4 medical ICUs. At least 2 structured family meetings led by palliative care specialists and provision of an informational brochure was compared with provision of an informational brochure and routine family meetings conducted by ICU teams. Researchers found:

• At 3 months, there was no significant difference in anxiety and depression symptoms between surrogate decision makers in the intervention group and the control group.

• PTSD symptoms were higher in the intervention group vs control group.

• There was no difference between groups regarding the discussion of patient preferences.

• Median number of hospital days for patients in the intervention group vs the control group (19 days vs 23 days, respectively) and 90-day survival (HR, 0.95) were not significantly different.

Citation: Carson SS, Cox CE, Wallenstein S, et al. Effect of palliative care-led meetings for families of patients with chronic crucial illness. A randomized clinical trial. JAMA. 2016;316(1)51-62. doi:10.1001/jama.2016.8474.

Commentary: Chronic critical illness occurs when a patient has an acute illness that requires prolonged mechanical ventilation or other life-sustaining therapy but does not recover or die within weeks. Approximately two-thirds of these patients do not survive past 1 year and most require long-term institutional support. In this context of severe illness, it surprisingly does not appear that formal palliative care consultation is helpful to families. This is not to say that compassionate sharing of information is not helpful, as one of the important reasons for this result is that the ICU teams randomized to the control group may have been skilled in providing that information. The take-home point here is that information is important to the care of patients and their families and that information given by either palliative care teams or the primary team can be effective in these difficult situations. —Neil Skolnik, MD