Impact of an intensive communication strategy on end-of-life practices in the intensive care unit

Autor: Jean-Philippe Rigaud, Arnaud Pavon, Christian Hervé, Saber Barbar, Grégoire Moutel, Pierre Emmanuel Charles, Sébastien Prin, Nicolas Jacquiot, Jean-Pierre Quenot, Bernard Blettery, Mael Hamet
Přispěvatelé: Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de Réanimation Polyvalente, Centre hospitalier de Dieppe, Laboratoire d'éthique médicale et médecine légale (LEM), Université Paris Descartes - Paris 5 (UPD5), Duchange, Nathalie
Rok vydání: 2011
Předmět:
MESH: Decision Making
Male
Pediatrics
Medical audit
Critical Care and Intensive Care Medicine
MESH: Medical Audit
law.invention
0302 clinical medicine
law
030212 general & internal medicine
Hospital Mortality
Practice Patterns
Physicians'
MESH: Aged
Medical Audit
Terminal Care
Withholding Treatment
MESH: Middle Aged
Medical record
MESH: Withholding Treatment
Middle Aged
16. Peace & justice
Intensive care unit
Icu admission
MESH: Terminal Care
Intensive Care Units
MESH: Interdisciplinary Communication
Female
France
medicine.medical_specialty
Decision Making
Article
03 medical and health sciences
Anesthesiology
Intensive care
medicine
Humans
MESH: Hospital Mortality
MESH: Physician's Practice Patterns
Aged
MESH: Humans
business.industry
030208 emergency & critical care medicine
[SDV.ETH] Life Sciences [q-bio]/Ethics
MESH: Male
[SDV.ETH]Life Sciences [q-bio]/Ethics
MESH: France
Median time
MESH: Intensive Care Units
Interdisciplinary Communication
business
MESH: Female
Zdroj: Intensive Care Med
Intensive Care Med, 2012, 38 (1), pp.145-52. ⟨10.1007/s00134-011-2405-z⟩
Intensive Care Med, 2012, 38 (1), pp.145-52. 〈10.1007/s00134-011-2405-z〉
ISSN: 1432-1238
DOI: 10.1007/s00134-011-2405-z⟩
Popis: International audience; PURPOSE: Since the 2005 French law on end of life and patients' rights, it is unclear whether practices have evolved. We investigated whether an intensive communication strategy based on this law would influence practices in terms of withholding and withdrawing treatment (WWT), and outcome of patients hospitalised in intensive care (ICU). METHODS: This was a single-centre, two-period study performed before and after the 2005 law. Between these periods, an intensive strategy for communication was developed and implemented, comprising regular meetings and modalities for WWT. We examined medical records of all patients who died in the ICU or in hospital during both periods. RESULTS: In total, out of 2,478 patients admitted in period 1, 678 (27%) died in the ICU and 823/2,940 (28%) in period 2. In period 1, among patients who died in the ICU, 45% died subsequent to a decision to WWT versus 85% in period 2 (p < 0.01). Among these, median time delay between ICU admission and initiation of decision-making process was significantly different (6-7 days in period 1 vs. 3-5 days in period 2, p < 0.05). Similarly, median time from admission to actual WWT decision was significantly shorter in period 2 (11-13 days in period 1 vs. 4-6 days in period 2, p < 0.05). Finally, median time from admission to death in the ICU subsequent to a decision to WWT was 13-15 days in period 1 versus 7-8 days in period 2, p < 0.05. Reasons for WWT were not significantly different between periods. CONCLUSION: Intensive communication brings about quicker end-of-life decision-making in the ICU. The new law has the advantage of providing a legal framework.
Databáze: OpenAIRE
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