District nurses' attitudes toward patient consent: the case of mechanical ventilation on amyotrophic lateral sclerosis patients: results from a French national survey.
OBJECTIVE
In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses' attitudes toward terminally ill patients' autonomy.


METHODS
We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses' religiosity, nurses' attitudes toward living wills, and patient sex.


RESULTS
Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent.


CONCLUSIONS
A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient's will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship.
Peretti-Watel
Patrick
P
INSERM, UMR379, Institut Paoli-Calmettes, Epidemiology and Social Sciences Unit, F-13000 Marseille, France.
Bendiane
Marc-Karim
MK
Galinier
Anne
A
Favre
Roger
R
Ribiere
Claude
C
Lapiana
Jean-Marc
JM
Obadia
Yolande
Y
D000328:Adult; D000367:Age Factors; D000690:Amyotrophic Lateral Sclerosis / Q000451:nursing*; D001291:Attitude of Health Personnel; D005260:Female; D005602:France; D006801:Humans; D016224:Living Wills; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses; D012067:Religion; D012121:Respiration, Artificial / Q000451:nursing*; D012737:Sex Factors; D013727:Terminal Care / Q000379:methods*; D014140:Tracheotomy / Q000706:statistics & numerical data