Skip to main content

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

Intensive Care Medicine volume 43, pages 473–484 (2017)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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 Clinicaltrials.gov Identifier: NCT02325297.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Angus DC, Barnato AE, Linde-Zwirble WT et al (2004) Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med 32(3):638–643

    Article  PubMed  Google Scholar 

  2. Long AC, Kross EK, Davydow DS, Curtis JR (2014) Posttraumatic stress disorder among survivors of critical illness: creation of a conceptual model addressing identification, prevention, and management. Intensive Care Med 40(6):820–829

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lautrette A, Garrouste-Orgeas M, Bertrand PM et al (2015) Respective impact of no escalation of treatment, withholding and withdrawal of life-sustaining treatment on ICU patients’ prognosis: a multicenter study of the Outcomerea Research Group. Intensive Care Med 41(10):1763–1772

    Article  PubMed  Google Scholar 

  4. Pochard F, Azoulay E, Chevret S et al (2001) Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 29(10):1893–1897

    CAS  Article  PubMed  Google Scholar 

  5. Kentish-Barnes N, Chaize M, Seegers V et al (2015) Complicated grief after death of a relative in the intensive care unit. Eur Respir J 45(5):1341–1352

    Article  PubMed  Google Scholar 

  6. Azoulay E, Pochard F, Kentish-Barnes N et al (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171(9):987–994

    Article  PubMed  Google Scholar 

  7. Kentish-Barnes N, Prigerson HG (2016) Is this bereaved relative at risk of prolonged grief? Intensive Care Med 42(8):1279–1281

    Article  PubMed  Google Scholar 

  8. Lautrette A, Darmon M, Megarbane B et al (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356(5):469–478

    CAS  Article  PubMed  Google Scholar 

  9. Curtis JR, Treece PD, Nielsen EL et al (2016) Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med 193(2):154–162

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nelson JE, Puntillo KA, Pronovost PJ et al (2010) In their own words: patients and families define high-quality palliative care in the intensive care unit. Crit Care Med 38(3):808–818

    Article  PubMed  PubMed Central  Google Scholar 

  11. Prigerson HG, Maciejewski PK, Reynolds CF 3rd et al (1995) Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 59(1–2):65–79

    CAS  Article  PubMed  Google Scholar 

  12. Maciejewski PK, Zhang B, Block SD, Prigerson HG (2007) An empirical examination of the stage theory of grief. JAMA 297(7):716–723

    CAS  Article  PubMed  Google Scholar 

  13. Bedell SE, Cadenhead K, Graboys TB (2001) The doctor’s letter of condolence. N Engl J Med 344(15):1162–1164

    CAS  Article  PubMed  Google Scholar 

  14. Morris SE, Block SD (2015) Adding value to palliative care services: the development of an institutional bereavement program. J Palliat Med 18(11):915–922

    Article  PubMed  Google Scholar 

  15. Kane RL, Klein SJ, Bernstein L, Rothenberg R (1986) The role of hospice in reducing the impact of bereavement. J Chronic Dis 39(9):735–742

    CAS  Article  PubMed  Google Scholar 

  16. Kentish-Barnes N, Seegers V, Legriel S et al (2016) CAESAR: a new tool to assess relatives’ experience of dying and death in the ICU. Intensive Care Med 42(6):995–1002

    Article  PubMed  Google Scholar 

  17. Lautrette A, Ciroldi M, Ksibi H, Azoulay E (2006) End-of-life family conferences: rooted in the evidence. Crit Care Med 34(11 Suppl):S364–S372

    Article  PubMed  Google Scholar 

  18. Kentish-Barnes N, McAdam JL, Kouki S et al (2015) Research participation for bereaved family members: experience and insights from a qualitative study. Crit Care Med 43(9):1839–1845

    Article  PubMed  Google Scholar 

  19. Azoulay E, Chaize M, Kentish-Barnes N (2014) Involvement of ICU families in decisions: fine-tuning the partnership. Ann Intensive Care. 4(37):37

    Article  PubMed  PubMed Central  Google Scholar 

  20. Curtis JR, Sprung CL, Azoulay E (2014) The importance of word choice in the care of critically ill patients and their families. Intensive Care Med 40(4):606–608

    Article  PubMed  Google Scholar 

  21. Jabre P, Tazarourte K, Azoulay E et al (2014) Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Med 40(7):981–987

    Article  PubMed  Google Scholar 

  22. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    CAS  Article  PubMed  Google Scholar 

  23. Ghesquiere AR, Park M, Bogner HR, Greenberg RL, Bruce ML (2014) The effect of recent bereavement on outcomes in a primary care depression intervention study. Am J Geriatr Psychiatry 22(12):1555–1564

    Article  PubMed  Google Scholar 

  24. Jones C (2014) What’s new on the post-ICU burden for patients and relatives? Intensive Care Med 39(10):1832–1835

    Article  Google Scholar 

  25. Herridge MS, Moss M, Hough CL et al (2016) Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 42(5):725–738

    Article  PubMed  Google Scholar 

  26. Kentish-Barnes N, Chevret S, Azoulay E (2016) Impact of the condolence letter on the experience of bereaved families after a death in intensive care: study protocol for a randomized controlled trial. Trials 17(1):102

    Article  PubMed  PubMed Central  Google Scholar 

  27. Curtis JR, White DB (2008) Practical guidance for evidence-based ICU family conferences. Chest 134(4):835–843

    Article  PubMed  PubMed Central  Google Scholar 

  28. Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG (2008) Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med 36(6):1722–1728

    Article  PubMed  Google Scholar 

  29. Cuthbertson SJ, Margetts MA, Streat SJ (2000) Bereavement follow-up after critical illness. Crit Care Med 28(4):1196–1201

    CAS  Article  PubMed  Google Scholar 

  30. Ferrell B, Connor SR, Cordes A et al (2007) The national agenda for quality palliative care: the National Consensus Project and the National Quality Forum. J Pain Symptom Manag 33(6):737–744

    Article  Google Scholar 

  31. National Consensus Project for Quality Palliative Care (2004) Clinical Practice Guidelines for quality palliative care, executive summary. J Palliat Med 7(5):611–627

    Article  Google Scholar 

  32. Curtis JR, Back AL, Ford DW et al (2013) Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. JAMA 310(21):2271–2281

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Carson SS, Cox CE, Wallenstein S et al (2016) Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 316(1):51–62

    CAS  Article  PubMed  Google Scholar 

  34. Charlton R, Dolman E (1995) Bereavement: a protocol for primary care. Br J Gen Pract 45(397):427–430

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Corn BW, Shabtai E, Merimsky O et al (2010) Do oncologists engage in bereavement practices? A survey of the Israeli Society of Clinical Oncology and Radiation Therapy (ISCORT). Oncologist 15(3):317–326

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chau NG, Zimmermann C, Ma C, Taback N, Krzyzanowska MK (2009) Bereavement practices of physicians in oncology and palliative care. Arch Intern Med 169(10):963–971

    Article  PubMed  Google Scholar 

  37. Kusano AS, Kenworthy-Heinige T, Thomas CR Jr (2012) Survey of bereavement practices of cancer care and palliative care physicians in the Pacific Northwest United States. J Oncol Pract 8(5):275–281

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sullivan DR, Liu X, Corwin DS et al (2012) Learned helplessness among families and surrogate decision-makers of patients admitted to medical, surgical, and trauma ICUs. Chest 142(6):1440–1446

    Article  PubMed  PubMed Central  Google Scholar 

  39. Dangler LA, O’Donnell J, Gingrich C, Bope ET (1996) What do family members expect from the family physician of a deceased loved one? Fam Med 28(10):694–697

    CAS  PubMed  Google Scholar 

  40. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML (2014) Primary care providers’ bereavement care practices: recommendations for research directions. Int J Geriatr Psychiatry 29(12):1221–1229

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

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

    Nancy Kentish-Barnes, Virginie Souppart, Marion Galon, Zoé Cohen-Solal & Elie Azoulay

  2. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-Louis, Paris, France

    Sylvie Chevret

  3. Assistance Publique, Hôpitaux de Paris, Cochin University Hospital, Paris, France

    Benoît Champigneulle

  4. Victor Dupouy Hospital, Argenteuil, France

    Marina Thirion

  5. Sud Francilien Hospital, Corbeil-Essonnes, France

    Marion Gilbert

  6. La Rochelle Hospital, La Rochelle, France

    Olivier Lesieur

  7. Cavale Blanche University Hospital, Brest, France

    Anne Renault

  8. Saint Joseph Hospital, Paris, France

    Maïté Garrouste-Orgeas

  9. Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon Est University, Lyon, France

    Laurent Argaud

  10. Assistance Publique, Hôpitaux de Paris, Saint-Louis University Hospital, Paris, France

    Marion Venot

  11. Assistance Publique, Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France

    Alexandre Demoule

  12. Saint André University Hospital, Bordeaux, France

    Olivier Guisset

  13. Les Oudairies Hospital, La Roche sur Yon, France

    Isabelle Vinatier

  14. Versailles Hospital, Versailles, France

    Gilles Troché

  15. Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Julien Massot

  16. Saint Eloi University Hospital, and Inserm U-1046, Montpellier, France

    Samir Jaber

  17. Le Raincy-Montfermeil Hospital, Montfermeil, France

    Caroline Bornstain

  18. René-Dubos Hospital, Pontoise, France

    Véronique Gaday

  19. Poitiers University Hospital and Poitiers University and Inserm CIC 1402, Poitiers, France

    René Robert

  20. Dieppe Hospital, Dieppe, France

    Jean-Philippe Rigaud

  21. Hôtel Dieu University Hospital, Nantes, France

    Raphaël Cinotti

  22. Assistance Publique, Hôpitaux de Marseille, Hôpital Nord University Hospital, Marseille, France

    Mélanie Adda

  23. Sud Amiens University Hospital, Amiens, France

    François Thomas

  24. Gabriel Montpied University Hospital, Clermont-Ferrand, France

    Laure Calvet

  25. Assistance Publique, Hôpitaux de Paris, Cochin University Hospital, Paris Descartes University, Paris, France

    Alain Cariou

  26. Medical Intensive Care Unit, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University , 1 rue Claude Vellefaux, 75010, Paris, France

    Elie Azoulay

Authors
  1. Nancy Kentish-Barnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sylvie Chevret
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benoît Champigneulle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marina Thirion
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Virginie Souppart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marion Gilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olivier Lesieur
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anne Renault
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maïté Garrouste-Orgeas
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Laurent Argaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marion Venot
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alexandre Demoule
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Olivier Guisset
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Isabelle Vinatier
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Gilles Troché
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Julien Massot
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Samir Jaber
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Caroline Bornstain
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Véronique Gaday
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. René Robert
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Jean-Philippe Rigaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Raphaël Cinotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Mélanie Adda
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. François Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Laure Calvet
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Marion Galon
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Zoé Cohen-Solal
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Alain Cariou
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Elie Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Famirea Study Group

Corresponding author

Correspondence to Elie Azoulay.

Ethics declarations

Funding

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

Additional information

This study was performed on behalf of the Famirea Study Group.

All contributors are listed in the Electronic supplementary material 1.

Electronic supplementary material

Appendices

Appendix 1: Participating ICUs

  Investigator name City Hospital Type of intensive care
1 Marion Venot Paris Saint Louis Medical intensive care
2 Benoît Champigneulle Paris Cochin Medical intensive care
3 Maité Garrouste Paris Saint Joseph General intensive care
4 Gilles Troche Le Chesnay-Versailles André Mignot General intensive care
5 Olivier Guisset Bordeaux Saint André Medical intensive care
6 Anne Renault Brest Cavale Blanche Medical intensive care
7 Laurent Argaud Lyon Edouard Herriot Medical intensive care
8 Mélanie Adda Marseille Hôpital Nord Medical intensive care
9 Jean-Philippe Rigaud Dieppe CH de Dieppe General intensive care
10 Isabelle Vinatier La Roche-sur-Yon Les Oudairies General intensive care
11 Samir Jaber Montpellier Saint Eloi General intensive care
12 Marina Thirion Argenteuil CH Victor Dupouy General intensive care
13 Olivier Lesieur La Rochelle CH de la Rochelle General intensive care
14 René Robert Poitiers CHU de Poitiers Medical intensive care
15 Raphaël Cinotti Nantes CHU de Nantes Surgical intensive care
16 Laure Calvet Clermont Ferrand CHU Gabriel Montpied General intensive care
17 Caroline Bornstain Montfermeil CHI Le Raincy General intensive care
18 Marion Gilbert Corbeil-Essones CH Sud-Francilien General intensive care
19 Véronique Gaday Pontoise CH René Dubos General intensive care
20 Alexandre Demoule Paris La Pitié-Salpêtrière Medical intensive care
21 François Thomas Amiens CHU Amiens-Picardie Hôpital Sud Nephrology intensive care
22 Julien Massot Paris HEGP Anesthesia-surgical intensive care

Appendix 2

Recommendations for writing a condolence letter and examples

Why write a condolence letter?

  • To help family members in the bereavement process: the letter helps relatives feel recognized in their pain and not abandoned by the hospital team,

  • to help family members manage potential feelings of anger or lack of understanding following an unexpected death,

  • to help the physician take stock of the patient’s death,

  • to bring closure to the relationship between caregivers and the families of the deceased patient.

Recommendations for writing a condolence letter

The condolence letter must be handwritten

  • Avoid superficial expressions like “I know what you’re feeling”.

  • Don’t write too formal a letter!

  • Please be sure to integrate the following five domains.

Five domains to include in the letter:

  1. 1.

    Recognize the death—name the deceased

    • The importance of naming the deceased.

    • Reduces the feeling of loneliness of the family member.

  2. 2.

    Talk about the deceased

    • If possible, personality, age, interests (sports, religion…).

    • If possible, mention a specific memory of the deceased.

    • If possible, mention the relationship of the deceased with the family member.

  3. 3.

    Recognize the family member

    • Personality, strengths (to recognize a potential for coping effectively).

    • Mention what the family member did for or with the patient in ICU (frequent visits, participating in care, etc.).

    • Or even the relationship of the family member with the ICU team.

  4. 4.

    Offer help: the possibility of contacting you

    • Be specific (phone number of the ICU).

  5. 5.

    Express your sympathy (conclusion)

    • Symbolize a shared emotion.

Examples

  1. 1.

    Recognize the death and name the deceased

I send you my sincere condolences on the death of your sister, Alison Smith. Natalie, who was your sister’s nurse, joins me in expressing our sympathy.

  1. 2.

    Mention the deceased

    1. (a)

      Patient who was conscious and able to communicate:

We had the opportunity to get to know your brother during his stay in our unit. He was very brave. His smile and his words touched us often. His caregivers were always happy to go into his room.

Or

We had the opportunity to get to know your mother during her stay in our unit. She was very brave. We understood her need to be cared for and reassured and we hope we were able to comfort her in the difficult moments.

  1. (b)

    Patient who was conscious but had difficulty communicating:

We had the opportunity to get to know your brother during his stay in our unit. He seemed very brave. He tried to communicate with us in different ways, for example using the whiteboard we gave him, even though we know it was sometimes difficult for him.

  1. (c)

    Patient who was never conscious in the ICU.

We did not have the opportunity to really get to know your aunt and we regret that. However, thanks to her family members, we could see that she was a kind and brave woman and we did our best to care for her and help her with kindness and respect.

  1. 3.

    Recognize the family member.

You were very present during his stay, ready to assist and be present for your brother. In my experience as a physician, I believe that the presence and support of a family member brings peace and serenity to those who are at the end of life.

  1. 4.

    Offer help.

I remain at your service if you wish to ask any questions or simply discuss your brother’s stay in intensive care. Please feel free to call us at [telephone number].

  1. 5.

    Express your sympathy (conclusion).

We send you our warmest thoughts,

Dr. Doe.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kentish-Barnes, N., Chevret, S., Champigneulle, B. et al. Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial. Intensive Care Med 43, 473–484 (2017). https://doi.org/10.1007/s00134-016-4669-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-016-4669-9

Keywords

  • Letter of condolence
  • Bereaved relatives
  • Grief symptoms