title: [The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end-of-life: improvement of the withholding and withdrawing treatment decision-making process by an educational program. A monocenter prospective and retrospective pilot study].
abstract: OBJECTIVE
  To assess the impact of an educational program on the quality of the end-of-life decision (EOLD).
  
  
  METHODS
  Prospective study for 3 months in a surgical Intensive Care Unit (ICU) involving: staff training conferences and guidelines for documenting level-of-care staff conference; audit before and at 3 months; analysis of records for deceased patients. The main outcome measures the proportion of treatment-limitation in dying ICU patients; and the secondary outcomes the decision-making process and nurses' satisfaction.
  
  
  RESULTS
  Eighty-three patients were included; among them, 14 with EOLD. Pre-death palliative strategy increased from 51 % to 85 % with a persisting improvement of practices after 2 years. All steps of EOLD decision-making processes were traced in all such cases, 85 % being based on the proposed guidelines. Nursing team's satisfaction rate almost doubled to 70 %.
  
  
  CONCLUSIONS
  The study demonstrate staff members' capacity to quickly improve their procedures for palliative care when provided with appropriate tools to think about the process and come to a decision. Our data suggest the potential benefice to extend this program to the other specialties involved in the end-of-life process.
authors.affiliation: Hôpital Foch, service d'anesthésie, 92150 Suresnes, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Chastrusse
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fulgencio
authors.forename: Florence
authors.initials: F
authors.lastname: Julien
authors.forename: Brice
authors.initials: B
authors.lastname: Naudin
authors.forename: Vincent
authors.initials: V
authors.lastname: Argo
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
authors.forename: Edouard
authors.initials: E
authors.lastname: Ferrand
mesh_terms: D003657:Decision Making / Q000941:ethics / Q000502:physiology; D017598:Efficiency, Organizational; D006801:Humans; D010353:Patient Education as Topic / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000458:organization & administration / Q000592:standards; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence*; D017060:Patient Satisfaction / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011446:Prospective Studies; D058996:Quality Improvement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence*; D028761:Withholding Treatment / Q000331:legislation & jurisprudence*