title: Half the family members of intensive care unit patients do not want to share in the decision-making process: a study in 78 French intensive care units.
abstract: OBJECTIVE
  To evaluate the opinions of intensive care unit staff and family members about family participation in decisions about patients in intensive care units in France, a country where the approach of physicians to patients and families has been described as paternalistic.
  
  
  METHODS
  Prospective multiple-center survey of intensive care unit staff and family members.
  
  
  METHODS
  Seventy-eight intensive care units in university-affiliated hospitals in France.
  
  
  METHODS
  We studied 357 consecutive patients hospitalized in the 78 intensive care units and included in the study starting on May 1, 2001, with five patients included per intensive care unit.
  
  
  METHODS
  We recorded opinions and experience about family participation in medical decision making. Comprehension, satisfaction, and Hospital Anxiety and Depression Scale scores were determined in family members.
  
  
  RESULTS
  Poor comprehension was noted in 35% of family members. Satisfaction was good but anxiety was noted in 73% and depression in 35% of family members. Among intensive care unit staff members, 91% of physicians and 83% of nonphysicians believed that participation in decision making should be offered to families; however, only 39% had actually involved family members in decisions. A desire to share in decision making was expressed by only 47% of family members. Only 15% of family members actually shared in decision making. Effectiveness of information influenced this desire.
  
  
  CONCLUSIONS
  Intensive care unit staff should seek to determine how much autonomy families want. Staff members must strive to identify practical and psychological obstacles that may limit their ability to promote autonomy. Finally, they must develop interventions and attitudes capable of empowering families.
authors.affiliation: Intensive Care Unit of the Saint-Louis Teaching Hospital and University of Paris 7, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pochard
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Djilali
authors.initials: D
authors.lastname: Annane
authors.forename: Gérard
authors.initials: G
authors.lastname: Bleichner
authors.forename: Caroline
authors.initials: C
authors.lastname: Bornstain
authors.forename: Yves
authors.initials: Y
authors.lastname: Bouffard
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.forename: Marc
authors.initials: M
authors.lastname: Feissel
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Toledano
authors.forename: Christophe
authors.initials: C
authors.lastname: Guitton
authors.forename: Jan
authors.initials: J
authors.lastname: Hayon
authors.forename: Esther
authors.initials: E
authors.lastname: Iglesias
authors.forename: Luc-Marie
authors.initials: LM
authors.lastname: Joly
authors.forename: Mercé
authors.initials: M
authors.lastname: Jourdain
authors.forename: Christian
authors.initials: C
authors.lastname: Laplace
authors.forename: Christine
authors.initials: C
authors.lastname: Lebert
authors.forename: Juliette
authors.initials: J
authors.lastname: Pingat
authors.forename: Catherine
authors.initials: C
authors.lastname: Poisson
authors.forename: Anne
authors.initials: A
authors.lastname: Renault
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
authors.forename: Dominique
authors.initials: D
authors.lastname: Selcer
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Jean-Roger
authors.initials: JR
authors.lastname: Le Gall
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003258:Consumer Behavior; D003657:Decision Making; D003863:Depression; D005190:Family / Q000523:psychology*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies