title: Impact of an intensive communication strategy on end-of-life practices in the intensive care unit.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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: Service de Réanimation Médicale, CHU Dijon, Dijon, France. jean-pierre.quenot@chu-dijon.fr
authors: J P
authors: JP
authors: Quenot
authors: J P
authors: JP
authors: Rigaud
authors: S
authors: S
authors: Prin
authors: S
authors: S
authors: Barbar
authors: A
authors: A
authors: Pavon
authors: M
authors: M
authors: Hamet
authors: N
authors: N
authors: Jacquiot
authors: B
authors: B
authors: Blettery
authors: C
authors: C
authors: Hervé
authors: P E
authors: PE
authors: Charles
authors: G
authors: G
authors: Moutel
mesh_terms: D000368:Aged; D003657:Decision Making; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013727:Terminal Care / Q000331:legislation & jurisprudence*; D028761:Withholding Treatment / Q000331:legislation & jurisprudence