Document Detail


Impact of an intensive communication strategy on end-of-life practices in the intensive care unit.
MedLine Citation:
PMID:  22127479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
J P Quenot; J P Rigaud; S Prin; S Barbar; A Pavon; M Hamet; N Jacquiot; B Blettery; C Hervé; P E Charles; G Moutel
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Publication Detail:
Type:  Journal Article     Date:  2011-11-30
Journal Detail:
Title:  Intensive care medicine     Volume:  38     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-04-20     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  145-52     Citation Subset:  IM    
Affiliation:
Service de Réanimation Médicale, CHU Dijon, Dijon, France. jean-pierre.quenot@chu-dijon.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Decision Making
Female
France / epidemiology
Hospital Mortality
Humans
Intensive Care Units*
Interdisciplinary Communication*
Male
Medical Audit
Middle Aged
Physician's Practice Patterns*
Terminal Care / legislation & jurisprudence*
Withholding Treatment / legislation & jurisprudence
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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