Intensive Care Medicine

, Volume 43, Issue 4, pp 473–484 | Cite as

Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial

  • Nancy Kentish-Barnes
  • Sylvie Chevret
  • Benoît Champigneulle
  • Marina Thirion
  • Virginie Souppart
  • Marion Gilbert
  • Olivier Lesieur
  • Anne Renault
  • Maïté Garrouste-Orgeas
  • Laurent Argaud
  • Marion Venot
  • Alexandre Demoule
  • Olivier Guisset
  • Isabelle Vinatier
  • Gilles Troché
  • Julien Massot
  • Samir Jaber
  • Caroline Bornstain
  • Véronique Gaday
  • René Robert
  • Jean-Philippe Rigaud
  • Raphaël Cinotti
  • Mélanie Adda
  • François Thomas
  • Laure Calvet
  • Marion Galon
  • Zoé Cohen-Solal
  • Alain Cariou
  • Elie AzoulayEmail author
  • Famirea Study Group
Seven-Day Profile Publication



Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the closest relative a handwritten condolence letter.


Multicenter randomized trial conducted among 242 relatives of patients who died at 22 ICUs in France between December 2014 and October 2015. Relatives were randomly assigned to receiving (n = 123) or not receiving (n = 119) a condolence letter. The primary endpoint was the Hospital Anxiety and Depression Score (HADS) at 1 month. Secondary endpoints included HADS, complicated grief (ICG), and PTSD-related symptoms (IES-R) at 6 months. Observers were blinded to group allocation.


At 1 month, 208 (85.9%) relatives completed the HADS; median score was 16 [IQR, 10–22] with and 14 [8–21.5] without the letter (P = 0.36). Although scores were higher in the intervention group, there were no significant differences regarding the HADS-depression subscale (8 [4–12] vs. 6 [2–12], mean difference 1.1 [−0.5 to 2.6]; P = 0.09) and prevalence of depression symptoms (56.0 vs. 42.4%, RR 0.76 [0.57–1.00]; P = 0.05). At 6 months, 190 (78.5%) relatives were interviewed. The intervention significantly increased the HADS (13 [7–19] vs. 10 [4–17.5], P = 0.04), HADS-depression subscale (6 [2–10] vs. 3 [1–9], P = 0.02), prevalence of depression symptoms (36.6 vs. 24.7%, P = 0.05) and PTSD-related symptoms (52.4 vs. 37.1%, P = 0.03).


In relatives of patients who died in the ICU, a condolence letter failed to alleviate grief symptoms and may have worsened depression and PTSD-related symptoms.

Trial registration Identifier: NCT02325297.


Letter of condolence Bereaved relatives Grief symptoms 



We would like to thank Marine Chaize and Frédéric Pochard for their advice and thoughtful comments regarding the study.

Contributors: Virginie Lemiale MD, Sandrine Vallade MD from Assistance Publique, Hôpitaux de Paris, Saint-Louis University Hospital, Paris, France. Guillaume Géri MD, Wulfran Bougouin MD, Michel Arnaout MD, Lara Zafrani MD, Shirley Spagnolo MD, and Olivier Passouant MD from Assistance Publique, Hôpitaux de Paris, Cochin University Hospital, Paris, France. Gérald Choukroun MD and Laura Federicci MD from Sud Francilien Hospital, Corbeil-Essonnes, France. Alexandre Herbland MD and Maxime Leloup MD from La Rochelle Hospital, La Rochelle, France. Amelie Bazire MD and Pierre Bailly MD from Cavale Blanche University Hospital, Brest, France. Thomas Baudry MD, Romain Hernu MD, and Sylvie de la Salle RN from Hospices Civils de Lyon, Edouard Herriot Hospital and Lyon Est University, Lyon, France. Alexandre Demoule MD, PhD; Julien Mayaux MD from Assistance Publique, Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France. Sébastien Cavelot (CRA) and Sybille Merceron MD from Versailles Hospital, Versailles, France. Arnaud Follin MD, Gersande Fave MD, Anne-Laure Constant MD, and Vibol Chhor MD from Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France. Julie Carr MD, Audrey De Jong MD, and Albert Prades RN from Saint Eloi University Hospital, Montpellier, France. Vincent Francois MD from Le Raincy-Montfermeil Hospital, Montfermeil, France. Marie Thuong MD from René-Dubos Hospital, Pontoise, France. Séverin Cabason MD from Poitiers University Hospital and Poitiers University, Poitiers, France. Stéphanie Gelinotte MD from Dieppe Hospital, Dieppe, France. Laurent Papazian MD PhD, Jean-Marie Forel MD, Christophe Guervilly MD, Sami Hraiech MD, PhD, Samuel Lehingue MD, Romain Rambaud MD, Elisa Marchi MD, and Pierre Esnault MD from Hôpital Nord University Hospital, Marseille, France. Michel Slama MD, PhD, Julien Maizel MD, and Thierry Soupison MD from Sud Amiens University Hospital, Amiens, France. Bertrand Souweine MD, PhD from Gabriel Montpied University Hospital, Clermont-Ferrand, France.

Compliance with ethical standards


Grant from the Fondation de France, a non-profit institution.

Supplementary material

134_2016_4669_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 17 kb)
134_2016_4669_MOESM2_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)
134_2016_4669_MOESM3_ESM.docx (2.1 mb)
Supplementary material 2 (DOCX 2198 kb)
134_2016_4669_MOESM4_ESM.pdf (370 kb)
Supplementary material 3 (PDF 370 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Nancy Kentish-Barnes
    • 1
  • Sylvie Chevret
    • 2
  • Benoît Champigneulle
    • 3
  • Marina Thirion
    • 4
  • Virginie Souppart
    • 1
  • Marion Gilbert
    • 5
  • Olivier Lesieur
    • 6
  • Anne Renault
    • 7
  • Maïté Garrouste-Orgeas
    • 8
  • Laurent Argaud
    • 9
  • Marion Venot
    • 10
  • Alexandre Demoule
    • 11
  • Olivier Guisset
    • 12
  • Isabelle Vinatier
    • 13
  • Gilles Troché
    • 14
  • Julien Massot
    • 15
  • Samir Jaber
    • 16
  • Caroline Bornstain
    • 17
  • Véronique Gaday
    • 18
  • René Robert
    • 19
  • Jean-Philippe Rigaud
    • 20
  • Raphaël Cinotti
    • 21
  • Mélanie Adda
    • 22
  • François Thomas
    • 23
  • Laure Calvet
    • 24
  • Marion Galon
    • 1
  • Zoé Cohen-Solal
    • 1
  • Alain Cariou
    • 25
  • Elie Azoulay
    • 1
    • 26
    Email author
  • Famirea Study Group
  1. 1.Assistance Publique, Hôpitaux de ParisSaint-Louis University Hospital, Famiréa Research GroupParisFrance
  2. 2.ECSTRA Team, Biostatistics and Clinical EpidemiologyUMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-LouisParisFrance
  3. 3.Assistance Publique, Hôpitaux de ParisCochin University HospitalParisFrance
  4. 4.Victor Dupouy HospitalArgenteuilFrance
  5. 5.Sud Francilien HospitalCorbeil-EssonnesFrance
  6. 6.La Rochelle HospitalLa RochelleFrance
  7. 7.Cavale Blanche University HospitalBrestFrance
  8. 8.Saint Joseph HospitalParisFrance
  9. 9.Hospices Civils de Lyon, Edouard Herriot HospitalLyon Est UniversityLyonFrance
  10. 10.Assistance Publique, Hôpitaux de ParisSaint-Louis University HospitalParisFrance
  11. 11.Assistance Publique, Hôpitaux de ParisLa Pitié-Salpêtrière University HospitalParisFrance
  12. 12.Saint André University HospitalBordeauxFrance
  13. 13.Les Oudairies HospitalLa Roche sur YonFrance
  14. 14.Versailles HospitalVersaillesFrance
  15. 15.Assistance Publique, Hôpitaux de ParisHôpital Européen Georges PompidouParisFrance
  16. 16.Saint Eloi University Hospital, and Inserm U-1046MontpellierFrance
  17. 17.Le Raincy-Montfermeil HospitalMontfermeilFrance
  18. 18.René-Dubos HospitalPontoiseFrance
  19. 19.Poitiers University Hospital and Poitiers University and Inserm CIC 1402PoitiersFrance
  20. 20.Dieppe HospitalDieppeFrance
  21. 21.Hôtel Dieu University HospitalNantesFrance
  22. 22.Assistance Publique, Hôpitaux de MarseilleHôpital Nord University HospitalMarseilleFrance
  23. 23.Sud Amiens University HospitalAmiensFrance
  24. 24.Gabriel Montpied University HospitalClermont-FerrandFrance
  25. 25.Assistance Publique, Hôpitaux de ParisCochin University Hospital, Paris Descartes UniversityParisFrance
  26. 26.Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERMParis Diderot Sorbonne University ParisFrance

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