Titre :

Impact of advance directives on the variability between intensivists in the decisions to forgo life-sustaining treatment

Auteur(s) :

Smirdec, Margot [Auteur]
Jourdain, Mercedes [Auteur]
Recherche translationnelle sur le diabète (RTD) - U1190
Guastella, Virginie [Auteur]
Lambert, Céline [Auteur]
Richard, Jean-Christophe [Auteur]
Argaud, Laurent [Auteur]
Jaber, Samir [Auteur]
Klouche, Kada [Auteur]
Medard, Anne [Auteur]
Reignier, Jean [Auteur]
Rigaud, Jean-Philippe [Auteur]
Doise, Jean-Marc [Auteur]
Chabanne, Russell [Auteur]
Souweine, Bertrand [Auteur]
Bourenne, Jeremy [Auteur]
Delmas, Julie [Auteur]
Bertrand, Pierre-Marie [Auteur]
Verdier, Philippe [Auteur]
Quenot, Jean-Pierre [Auteur]
Aubron, Cécile [Auteur]
Eisenmann, Nathanael [Auteur]
Asfar, Pierre [Auteur]
Fratani, Alexandre [Auteur]
Dellamonica, Jean [Auteur]
Terzi, Nicolas [Auteur]
Constantin, Jean-Michel [Auteur]
Van Lander, Axelle [Auteur]
Guerin, Renaud [Auteur]
Pereira, Bruno [Auteur]
Lautrette, Alexandre [Auteur]

Titre de la revue :

Critical Care

Nom court de la revue :

Crit Care

Numéro :

24

Pagination :

672

Éditeur :

BioMed Central

Date de publication :

2020-12-02

ISSN :

1466-609X

Mot(s)-clé(s) en anglais :

Advance directives
Decisions to forgo life-sustaining treatment
ICU

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background There is wide variability between intensivists in the decisions to forgo life-sustaining treatment (DFLST). Advance directives (ADs) allow patients to communicate their end-of-life wishes to physicians. We ...
Lire la suite >Background There is wide variability between intensivists in the decisions to forgo life-sustaining treatment (DFLST). Advance directives (ADs) allow patients to communicate their end-of-life wishes to physicians. We assessed whether ADs reduced variability in DFLSTs between intensivists. Methods We conducted a multicenter, prospective, simulation study. Eight patients expressed their wishes in ADs after being informed about DFLSTs by an intensivist-investigator. The participating intensivists answered ten questions about the DFLSTs of each patient in two scenarios, referring to patients’ characteristics without ADs (round 1) and then with (round 2). DFLST score ranged from 0 (no-DFLST) to 10 (DFLST for all questions). The main outcome was variability in DFLSTs between intensivists, expressed as relative standard deviation (RSD). Results A total of 19,680 decisions made by 123 intensivists from 27 ICUs were analyzed. The DFLST score was higher with ADs than without (6.02 95% CI [5.85; 6.19] vs 4.92 95% CI [4.75; 5.10], p < 0.001). High inter-intensivist variability did not change with ADs (RSD: 0.56 (round 1) vs 0.46 (round 2), p = 0.84). Inter-intensivist agreement on DFLSTs was weak with ADs (intra-class correlation coefficient: 0.28). No factor associated with DFLSTs was identified. A qualitative analysis of ADs showed focus on end-of-life wills, unwanted things and fear of pain. Conclusions ADs increased the DFLST rate but did not reduce variability between the intensivists. In the decision-making process using ADs, the intensivist’s decision took priority. Further research is needed to improve the matching of the physicians’ decision with the patient’s wishes. Trial registration ClinicalTrials.gov Identifier: NCT03013530. Registered 6 January 2017; https://clinicaltrials.gov/ct2/show/NCT03013530.Lire moins >

Langue :

Anglais

Comité de lecture :

Oui

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Recherche translationnelle sur le diabète (RTD) - U1190

Date de dépôt :

2024-01-19T23:17:29Z
2024-09-17T13:12:28Z