A multifaceted intervention strategy for relatives of patients who died in the emergency department: a randomized cluster trial.

In France, a study indicates that around 0.2% of patients visiting emergency departments die there. A survey of 145 emergency departments in three French-speaking countries reveals that, on average, two patients die each week in these departments and their observation units. Following the death of a loved one, some individuals develop prolonged grief disorder (PGD), characterized by deep nostalgia and fixation on the deceased, with a prevalence of 10% in the general population. A further 7% of adults suffer from post-traumatic stress disorder (PTSD), a mental disorder triggered by traumatic events, with symptoms such as flashbacks and intense anxiety. The experience of a loved one's death in hospital is strongly linked to an increased risk of PDD and PTSD in relatives.

Studies have shown that in the intensive care setting, simple interventions such as providing written information about end-of-life care and proactive communication significantly reduce the risk of PTSD and PDD in relatives. The presence of relatives during care can also be beneficial. Similarly, in the out-of-hospital setting, allowing relatives to attend resuscitations reduces post-traumatic stress.

However, the emergency context is different, not least because of the short time of exposure to the dying process and the staff's lesser familiarity with end-of-life management. It is uncertain whether beneficial strategies in intensive care are applicable in the ED, where patients are often older and suffer from chronic terminal illness.

The aim of this study is to evaluate the impact of a comprehensive, multifaceted intervention, including proactive communication, visual aids and the opportunity for relatives to be present during care, on the TDP of relatives of patients who have died in the emergency department. Primary assessment will be via the PG-R-13 scale six months after death. Secondary objectives include the effect on PTSD, depression, anxiety and the prescription of psychotropic drugs, with specific assessments for each of these aspects.