Intensive Care Med (2014) 40:1175–1176 DOI 10.1007/s00134-014-3371-z
Pierre Bouju Jean-Marc Tadie´ Fabrice Uhel Julien Letheulle Pierre Fillatre Sylvain Lavoue´ Christophe Camus Yves Le Tulzo Arnaud Gacouin
LETTER
proportion of families who resort to the Internet and their characteristics. For this purpose, we conducted a monocentric observational study between May 2012 and April 2013.
The study was approved by the hospital’s review board. Patients with ICU length of stay longer than 48 h were prospectively identified. All next of kin visiting the patient were
Table 1 Comparison of patient and family characteristics by family Internet use Characteristic
All patients Research on the Internet p-Value by patients’ visitors n = 222
Internet use by family members of intensive care unit patients: a pilot study Accepted: 7 June 2014 Published online: 28 June 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 Presented in part as an abstract at the SRLF Annual Congress, Paris 2014. Electronic supplementary material The online version of this article (doi:10.1007/s00134-014-3371-z) contains supplementary material, which is available to authorized users.
Dear Editor, The next of kin of critically ill patients experience stress during the intensive care unit (ICU) stay and may develop posttraumatic stress disorder [1, 2], which could be related to a lack of understanding between families and doctors [2, 3]. The Internet represents the most easily accessible source of medical information, and 60–80 % of adults have already searched the Internet for medical information [4]. Internet use by family members has already been assessed for patients from specialities other than intensive care medicine [5], but no study has ever focused on families of ICU patients. Before analyzing the impact of medical information research on the Internet on the physician–family relationship, it is necessary to estimate the
Patient characteristics Age, years (IQR) Male, n (%) SAPS II, points (IQR) McCabe’s scale, n (%) One Two Three Employment status, n (%) Retired Employed Unemployed Student Other Level of education, n (%) \9th grade 9th grade High-school graduation Bachelor’s degree or more Length of stay before ICU admission, days (IQR) Length of stay in ICU, days (IQR) Family characteristics Age, years (IQR) Male, n (%) Internet access at home, yes n (%) Prior use of the Internet for medical research, yes n (%) Employment status, n (%) Retired Employed Unemployed Student Other Level of education, n (%) \9th grade 9th grade High-school graduation Bachelor’s degree or more Relationship with the patient, n (%) Spouse Child Parent Sister or brother Other
Yes, n = 101
No, n = 121
61 (50–68) 150 (68) 43 (31–57)
58 (45–65) 62 (52–71) 71 (70) 79 (65) 40 (31–60) 45 (32–57)
115 (52) 74 (33) 33 (15)
48 (47) 32 (32) 21 (21)
67 (55) 42 (35) 12 (10)
108 63 24 7 20
(49) (28) (11) (3) (9)
43 34 13 1 10
(42) (34) (13) (1) (10)
65 29 11 6 10
(54) (24) (9) (5) (8)
(45) (22) (17) (16) (0–6) (6–18)
42 14 20 19 2 10
(44) (15) (21) (20) (0–7) (6–16)
43 28 12 11 1 9
(45) (30) (13) (12) (0–5) (6–20)
0.02 0.52 0.58 0.09
0.14
0.03 85 42 32 30 1 10
0.03 0.76
52 61 183 143
(39–62) 47 (35–55) (27) 30 (30) (82) 101 (100) (64) 99 (98)
56 31 82 44
(45–66) \0.0001 (26) 0.50 (68) \0.0001 (36) \0.0001
69 134 12 2 5
(31) (61) (5) (1) (2)
21 68 9 1 2
(21) (67) (9) (1) (2)
48 66 3 1 3
(40) (55) (2) (1) (2)
75 26 62 46
(35) (13) (30) (22)
25 6 42 27
(25) (6) (42) (27)
50 20 20 19
(46) (18) (18) (18)
108 58 25 24 6
(49) (26) (11) (11) (3)
44 32 10 14 1
(43) (32) (10) (14) (1)
64 26 15 10 5
(53) (22) (13) (8) (4)
0.02
\0.0001
0.13
Continuous variables reported as median (interquartile range), and categorical variables as number (percentage) IQR interquartile range (25th to 75th percentile), SAPS Simplified Acute Physiology Score, SOFA Sequential Organ Failure Assessment, ICU intensive care unit
1176
approached for survey completion on ICU days 3–5 if they had met with the physicians at least once. We designed a self-administered questionnaire for visitors (Supplementary Appendix). The questionnaire asked about sociodemographic characteristics, whether the visitors had searched the Internet, and the characteristics of that research. Finally, the respondents estimated the Internet’s influence on their understanding of the situation, their level of anxiety, and their communication with the medical team. The primary end-point was to determine the proportion of family members who carried out medical information Internet searches during the first days of the ICU stay. Secondary end-points included identification of the sociodemographic characteristics of the patients and their families that were associated with Internet information searches, reasons for Internet use, and the search strategy. During the study period, 726 patients stayed in the ICU for over 48 h. The questionnaire was completed by 222 (36 %) visitors (Supplementary Fig. 1). Before the sixth day, 45 % had used the Internet to search for medical information. Some patient and family member characteristics were associated with increased Internet use, including family age and education as well as patient length of stay (Table 1). The characteristics of the meeting preceding the delivery of the questionnaire are reported in Supplementary Table 1. Results of the survey about Internet use by visitors
are described in Supplementary Table 2. According to responders, the Internet seemed to have limited impact on the physician–family relationship, and only 49 % thought that Internet use was unavoidable. Supplementary Fig. 2 shows the percentage distribution of the clarity, reliability, and completeness of the information found on the Internet as estimated by the respondents. In conclusion, in our study, barely half of families had searched the Internet for medical information, and it was predictable by patient and family characteristics. Further studies are needed to evaluate the impact of Internet use on the comprehension and satisfaction of families and on the physician–family relationship.
3. Azoulay E, Chevret S, Leleu G, Pochard F, Barboteu M, Adrie C, Canoui P, Le Gall JR, Schlemmer B (2000) Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 28:3044–3049 4. Sechrest RC (2010) The internet and the physician–patient relationship. Clin Orthop 468:2566–2571 5. Plantin L, Daneback K (2009) Parenthood, information and support on the internet. A literature review of research on parents and professionals online. BMC Fam Pract 10:34 P. Bouju ()) J.-M. Tadie´ F. Uhel J. Letheulle P. Fillatre S. Lavoue´ C. Camus Y. Le Tulzo A. Gacouin CHU Rennes, Service des Maladies Infectieuses et Re´animation Me´dicale, 35033 Rennes, France e-mail: [email protected] Tel.: ?33-2-99284248
Conflicts of interest The authors declare that they have no conflict of interest. P. Bouju J.-M. Tadie´ F. Uhel J. Letheulle C. Camus Y. Le Tulzo A. Gacouin Faculte´ de Me´decine, Universite´ Rennes1, References Biosit, 35043 Rennes, France 1. McAdam JL, Dracup KA, White DB, Fontaine DK, Puntillo KA (2010) Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med 38:1078–1085 2. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, GarrousteOrgeas M, Georges H, GoldgranToledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Kentish Barnes N, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478
J.-M. Tadie´ F. Uhel Y. Le Tulzo Inserm-CIC-1414, Faculte´ de Me´decine, Universite´ Rennes I, IFRI 40, 35033 Rennes, France
Pierre Bouju Jean-Marc Tadie´ Fabrice Uhel Julien Letheulle Pierre Fillatre Sylvain Lavoue´ Christophe Camus Yves Le Tulzo Arnaud Gacouin
LETTER
proportion of families who resort to the Internet and their characteristics. For this purpose, we conducted a monocentric observational study between May 2012 and April 2013.
The study was approved by the hospital’s review board. Patients with ICU length of stay longer than 48 h were prospectively identified. All next of kin visiting the patient were
Table 1 Comparison of patient and family characteristics by family Internet use Characteristic
All patients Research on the Internet p-Value by patients’ visitors n = 222
Internet use by family members of intensive care unit patients: a pilot study Accepted: 7 June 2014 Published online: 28 June 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 Presented in part as an abstract at the SRLF Annual Congress, Paris 2014. Electronic supplementary material The online version of this article (doi:10.1007/s00134-014-3371-z) contains supplementary material, which is available to authorized users.
Dear Editor, The next of kin of critically ill patients experience stress during the intensive care unit (ICU) stay and may develop posttraumatic stress disorder [1, 2], which could be related to a lack of understanding between families and doctors [2, 3]. The Internet represents the most easily accessible source of medical information, and 60–80 % of adults have already searched the Internet for medical information [4]. Internet use by family members has already been assessed for patients from specialities other than intensive care medicine [5], but no study has ever focused on families of ICU patients. Before analyzing the impact of medical information research on the Internet on the physician–family relationship, it is necessary to estimate the
Patient characteristics Age, years (IQR) Male, n (%) SAPS II, points (IQR) McCabe’s scale, n (%) One Two Three Employment status, n (%) Retired Employed Unemployed Student Other Level of education, n (%) \9th grade 9th grade High-school graduation Bachelor’s degree or more Length of stay before ICU admission, days (IQR) Length of stay in ICU, days (IQR) Family characteristics Age, years (IQR) Male, n (%) Internet access at home, yes n (%) Prior use of the Internet for medical research, yes n (%) Employment status, n (%) Retired Employed Unemployed Student Other Level of education, n (%) \9th grade 9th grade High-school graduation Bachelor’s degree or more Relationship with the patient, n (%) Spouse Child Parent Sister or brother Other
Yes, n = 101
No, n = 121
61 (50–68) 150 (68) 43 (31–57)
58 (45–65) 62 (52–71) 71 (70) 79 (65) 40 (31–60) 45 (32–57)
115 (52) 74 (33) 33 (15)
48 (47) 32 (32) 21 (21)
67 (55) 42 (35) 12 (10)
108 63 24 7 20
(49) (28) (11) (3) (9)
43 34 13 1 10
(42) (34) (13) (1) (10)
65 29 11 6 10
(54) (24) (9) (5) (8)
(45) (22) (17) (16) (0–6) (6–18)
42 14 20 19 2 10
(44) (15) (21) (20) (0–7) (6–16)
43 28 12 11 1 9
(45) (30) (13) (12) (0–5) (6–20)
0.02 0.52 0.58 0.09
0.14
0.03 85 42 32 30 1 10
0.03 0.76
52 61 183 143
(39–62) 47 (35–55) (27) 30 (30) (82) 101 (100) (64) 99 (98)
56 31 82 44
(45–66) \0.0001 (26) 0.50 (68) \0.0001 (36) \0.0001
69 134 12 2 5
(31) (61) (5) (1) (2)
21 68 9 1 2
(21) (67) (9) (1) (2)
48 66 3 1 3
(40) (55) (2) (1) (2)
75 26 62 46
(35) (13) (30) (22)
25 6 42 27
(25) (6) (42) (27)
50 20 20 19
(46) (18) (18) (18)
108 58 25 24 6
(49) (26) (11) (11) (3)
44 32 10 14 1
(43) (32) (10) (14) (1)
64 26 15 10 5
(53) (22) (13) (8) (4)
0.02
\0.0001
0.13
Continuous variables reported as median (interquartile range), and categorical variables as number (percentage) IQR interquartile range (25th to 75th percentile), SAPS Simplified Acute Physiology Score, SOFA Sequential Organ Failure Assessment, ICU intensive care unit
1176
approached for survey completion on ICU days 3–5 if they had met with the physicians at least once. We designed a self-administered questionnaire for visitors (Supplementary Appendix). The questionnaire asked about sociodemographic characteristics, whether the visitors had searched the Internet, and the characteristics of that research. Finally, the respondents estimated the Internet’s influence on their understanding of the situation, their level of anxiety, and their communication with the medical team. The primary end-point was to determine the proportion of family members who carried out medical information Internet searches during the first days of the ICU stay. Secondary end-points included identification of the sociodemographic characteristics of the patients and their families that were associated with Internet information searches, reasons for Internet use, and the search strategy. During the study period, 726 patients stayed in the ICU for over 48 h. The questionnaire was completed by 222 (36 %) visitors (Supplementary Fig. 1). Before the sixth day, 45 % had used the Internet to search for medical information. Some patient and family member characteristics were associated with increased Internet use, including family age and education as well as patient length of stay (Table 1). The characteristics of the meeting preceding the delivery of the questionnaire are reported in Supplementary Table 1. Results of the survey about Internet use by visitors
are described in Supplementary Table 2. According to responders, the Internet seemed to have limited impact on the physician–family relationship, and only 49 % thought that Internet use was unavoidable. Supplementary Fig. 2 shows the percentage distribution of the clarity, reliability, and completeness of the information found on the Internet as estimated by the respondents. In conclusion, in our study, barely half of families had searched the Internet for medical information, and it was predictable by patient and family characteristics. Further studies are needed to evaluate the impact of Internet use on the comprehension and satisfaction of families and on the physician–family relationship.
3. Azoulay E, Chevret S, Leleu G, Pochard F, Barboteu M, Adrie C, Canoui P, Le Gall JR, Schlemmer B (2000) Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 28:3044–3049 4. Sechrest RC (2010) The internet and the physician–patient relationship. Clin Orthop 468:2566–2571 5. Plantin L, Daneback K (2009) Parenthood, information and support on the internet. A literature review of research on parents and professionals online. BMC Fam Pract 10:34 P. Bouju ()) J.-M. Tadie´ F. Uhel J. Letheulle P. Fillatre S. Lavoue´ C. Camus Y. Le Tulzo A. Gacouin CHU Rennes, Service des Maladies Infectieuses et Re´animation Me´dicale, 35033 Rennes, France e-mail: [email protected] Tel.: ?33-2-99284248
Conflicts of interest The authors declare that they have no conflict of interest. P. Bouju J.-M. Tadie´ F. Uhel J. Letheulle C. Camus Y. Le Tulzo A. Gacouin Faculte´ de Me´decine, Universite´ Rennes1, References Biosit, 35043 Rennes, France 1. McAdam JL, Dracup KA, White DB, Fontaine DK, Puntillo KA (2010) Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med 38:1078–1085 2. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, GarrousteOrgeas M, Georges H, GoldgranToledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Kentish Barnes N, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478
J.-M. Tadie´ F. Uhel Y. Le Tulzo Inserm-CIC-1414, Faculte´ de Me´decine, Universite´ Rennes I, IFRI 40, 35033 Rennes, France
