Study: Palliative care meetings for families not helpful, possibly harmful

Dealing with a sick or dying family member can be rough on caregivers and the rest of a patients’ support system. It's also often physically and emotionally painful for the patient, too.

Palliative care is designed to make the situation easier for both parties. But a new study published in the Journal of the American Medical Association found that discussing the methods used to make patients’ last days easier and offering emotional support for those family caregivers can actually end up making the process more difficult for families.

Experts had previously wondered if offering emotional support meetings and keeping family members involved in their loved ones’ care decisions could help relieve some of the stress that comes with caring for a sick or dying relative. These results contradict that hypothesis, the authors said.

The study examined 365 family members of 256 patients with “chronic critical illnesses” between 2010 and 2014. Some participants received normal check-ins with doctors, nurses and palliative care experts, while another randomly chosen group of 116 people attended at least one extra meeting with support and information teams. The meetings included discussions of the patients’ prognoses and communication of the families’ values and goals to the care team.

But the family members who participated in these meetings didn’t feel like their outlooks had improved within three months of the initial meetings. Their feelings were measured using the Hospital Anxiety and Depression Scale (HADS) and the Impact of Events Scale-Revised (IES-R), which measures post-traumatic stress disorder reactions.

Based on the HADS scores of the two groups (family members who had received meeting interventions and those who had not), feelings of anxiety or depression related to being a caregiver for a sick relative were not significantly reduced after attending the palliative care meetings. The group who had gone to meetings had an adjusted mean HADS score of 12.2, while the control group’s adjusted mean HADS score was 11.4. The 0.8-point difference was not significant, according to this study’s design.

The results were even less encouraging when it came to IES-R scores. Post-traumatic stress disorder responses in the intervention group (who went to the palliative care meetings) were more significant than the control group's. The intervention group’s adjusted mean IES-R score was 25.9, while the control group’s score was 21.3, which is significantly lower, according to this study’s design.

Those non-differences and differences in scores hold up even when taking into account patient survival rates and the different values held by the participating families.

The study’s authors interpreted these results to mean that even though attending palliative-led care meetings seems to make sense for caregivers with critically ill family members, the benefits are so small, nonexistent or even damaging that recommending or offering these meetings to patients’ families doesn’t make sense.