[The issue of dialysis withdrawal and palliative cares. A 3-year retrospective study carried out at Grenoble university teaching hospital development of a decision-making tool].
Dialysis-related constraints encourage questioning about discontinuation of treatment. In France, the 04/22/2005 law, related to patients' rights and end-of-life issues, defines bounds to treatment withdrawal, authorizing it in specific conditions, to avoid foolish obstinacy. Shortly before the publication of this law, a study has been conducted at Grenoble University Teaching Hospital, involving 31 patients followed by the dialysis service and the palliative care service, in order to analyse the circumstances in which withdrawals from dialysis happen. These patients were old and their general condition was very poor. After initiation of the questioning, treatment was removed in older patients and in those who had been dialysed for short time, which suggests they may have poor adaption to the treatment. No dialysis withdrawal was ever decided without the patient consent or without his nearest and dearest consent. After multidisciplinary discussions, a decision-making tool for dialysis withdrawal has been developed, with a view to be a starting point in the thinking process, for each decision to be adapted to each situation. This tool emphasizes the importance of time and collegial consultation in the decision-making process. It points out to that the decision lies with the referent nephrologist. After withdrawing dialysis, palliative cares must be implemented, since stopping the treatment does not mean stopping cares.
Jarrin
Guillemette
G
Service médical de l'Ain, place de la Grenouillère, 01000 Bourg-en-Bresse cedex, France.
Maurizi-Balzan
Jocelyne
J
Laval
Guillemette
G
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004501:Education, Medical; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome