Skip to Main content Skip to Navigation
Journal articles

Impact of an intensive communication strategy on end-of-life practices in the intensive care unit.

Abstract : PURPOSE: 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. CONCLUSION: Intensive communication brings about quicker end-of-life decision-making in the ICU. The new law has the advantage of providing a legal framework.
Document type :
Journal articles
Complete list of metadatas

Cited literature [30 references]  Display  Hide  Download

https://www.hal.inserm.fr/inserm-00655482
Contributor : Nathalie Duchange <>
Submitted on : Thursday, January 5, 2012 - 11:00:39 AM
Last modification on : Saturday, April 25, 2020 - 1:35:05 AM
Long-term archiving on: : Friday, April 6, 2012 - 2:20:59 AM

Files

Collegiality-Eng_R3-97-final2....
Files produced by the author(s)

Identifiers

Citation

Jean-Pierre Quenot, Jean-Philippe Rigaud, Sébastien Prin, Saber Barbar, Arnaud Pavon, et al.. Impact of an intensive communication strategy on end-of-life practices in the intensive care unit.. Intensive Care Med, 2012, 38 (1), pp.145-52. ⟨10.1007/s00134-011-2405-z⟩. ⟨inserm-00655482⟩

Share

Metrics

Record views

731

Files downloads

1718