Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions.
Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.
Unité de Réanimation Chirurgicale et Traumatologique, Service d'Anesthésie-Réanimation, Hôpital Henri-Mondor, AP-HP, 51 rue du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. edouard.ferrand@hmn.ap-hop-paris.fr
Edouard
E
Ferrand
François
F
Lemaire
Bernard
B
Regnier
Khaldoun
K
Kuteifan
Michel
M
Badet
Pierre
P
Asfar
Samir
S
Jaber
Jean-Luc
JL
Chagnon
Anne
A
Renault
René
R
Robert
Frédéric
F
Pochard
Christian
C
Herve
Christian
C
Brun-Buisson
Philippe
P
Duvaldestin
D001291:Attitude of Health Personnel; D016638:Critical Illness / Q000628:therapy; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000592:standards* / Q000639:trends; D016015:Logistic Models; D008297:Male; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D011336:Probability; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D028761:Withholding Treatment / Q000592:standards* / Q000639:trends