Les décisions médicales en fin de vie en France

PURPOSE We investigated, using a multicentre survey of practices in France, the practices of ICU physicians concerning the decision not to readmit to the ICU, in light of current legislation. MATERIALS AND METHODS Multicentre survey of practices among French ICU physicians via electronic questionnaire in January 2016. Questions related to respondents' practices regarding re-admission of patients to the ICU and how these decisions were made. Criteria were evaluated by the health care professionals as regards importance for non-readmission. RESULTS In total, 167 physicians agreed to participate, of whom 165 (99%) actually returned a completed questionnaire from 58 ICUs. Forty-five percent were aged <35 years, 74% were full-time physicians. The findings show that decisions for non-readmission are taken at the end of the patient's stay (87%), using a collegial decision-making procedure (89% of cases); 93% reported that this decision was noted in the patient's medical file. While 73% indicated that the family/relatives were informed of non-readmission decisions, only 29% reported informing the patient, and 91% considered that non-readmission decisions are an integral part of the French legislative framework. CONCLUSION This study shows that decisions not to re-admit a patient to the ICU need to be formally materialized, and anticipated by involving the patient and family in the discussions, as well as the other healthcare providers that usually care for the patient. The optimal time to undertake these conversations is likely best decided on a case-by-case basis according to each patient's individual characteristics.

/pdf/non-readmission-decisions-in-the-intensive-care-unit-under-2a9tztxyrz.pdf

Non-readmission decisions in the intensive care unit under French rules: A nationwide survey of practices.

/pdf/que-change-la-loi-claeys-leonetti-pour-les-reanimateurs-8n4fxd6xd3.pdf

Que change la Loi Claeys-Leonetti pour les réanimateurs ?

A new law developed by two members of the French parliament, A Claeys and J Leonetti, and passed on February 2, 2016, extends patients’ rights at the end of life. Although both euthanasia and assisted suicide remain illegal, “deep and continuous sedation until death” is allowed under certain circumstances. Furthermore, the new law encourages all individuals to make advance directives, which healthcare providers are now required to follow. Palliative care is given a greater role, as the law mandates an integrated approach that dovetails palliative care to curative care. Hydration and artificial nutrition are now classified as treatments, instead of supportive care, and can therefore be withdrawn from patients with treatment-limitation decisions. Thus, compared to the 2005 Leonetti law, this new piece of legislation has practical implications for patients and intensivists.

/pdf/new-french-law-on-the-end-of-life-claeys-leonetti-practical-ocqfbb1lry.pdf

New French Law on the End of Life (Claeys-Leonetti): Practical Implications for ICU Healthcare Providers

L’admission d’un patient en reanimation est a mettre en balance avec le benefice qui en est potentiellement attendu. Ainsi, certains patients ne sont pas admis en reanimation en argumentant d’un risque de deces eleve ou d’une qualite de vie devenue inacceptable au decours de l’hospitalisation le cas echeant, rendant cette derniere « futile ». Alors que les readmissions en reanimation ont un reel impact sur la morbi-mortalite, certains patients dont le parcours en reanimation a ete particulierement difficile font l’objet d’une decision de « non-readmission » en reanimation si l’indication devait a nouveau se poser. Les decisions de « non-admission » et de « non-readmission » en reanimation sont des decisions de limitation ou d’arret des therapeutiques (LAT), telles qu’elles ont ete definies par la loi du 22 avril 2005 dite « loi Leonetti » car elles conduisent a une limitation de moyens face a un patient dont la vie est (potentiellement) en danger. A notre connaissance, aucun travail publie jusqu’alors n’a etudie les decisions de « non-readmission » en reanimation. L’objectif de notre etude est de realiser une evaluation des pratiques professionnelles relatives aux decisions de non-readmission en reanimation. Materiel et Methodes : Entre le 01 decembre 2015 et le 31 janvier 2016, des medecins reanimateurs ont ete sollicites par voie electronique pour repondre a un questionnaire sur le theme de la non-readmission. Le questionnaire, comportant 27 questions, a ete elabore a l’aide d’un sociologue selon une methodologie validee dans la litterature. Les variables qualitatives ont ete exprimees en pourcentages et ont ete comparees en utilisant le test du Chi-2 ou le test exact de Fischer. Resultats : Cent soixante-cinq medecins ont repondu au questionnaire. Les decisions de non-readmission sont prises majoritairement en fin de sejour en reanimation (87% des cas) suite a une discussion collegiale (89% des cas). Neanmoins, les patients, les proches (et/ou famille), un medecin consultant exterieur ou le generaliste ne sont impliques dans la prise de decision que de maniere marginale (a hauteur respectivement de 10%, 34%, 14% et 29%). Si 73% des proches sont informes de ce type de decision, moins d’un tiers des patients ont recu cette information. Une fois la decision prise, celle-ci est notifiee dans le dossier du patient dans 93% des cas. Cependant, 96% des repondeurs considerent avoir la possibilite de ne pas tenir compte de cette decision le cas echeant. De plus, pour 92% des medecins, il existe clairement une difference entre une demande de readmission pour un episode aigu intercurrent et pour une aggravation d’une pathologie chronique. Par ailleurs, une prise en charge palliative n’est decidee de maniere conjointe a la decision de non-readmission dans seulement 41% des cas. Enfin, 91% des repondeurs considerent que les decisions de non-readmission font partie integrante de la loi du 22 avril 2005. Discussion : Notre travail met en evidence un processus decisionnel insuffisamment rigoureux sur les plans legal et ethique, notamment sur l’implication des patients dans la prise de decision concernant leur sante, sur l’information des patients, sur l’intervention d’un consultant exterieur ou encore la mise en place d’une demarche palliative. Afin de repondre a ces imperatifs et a la demande d’autonomisation des patients, notre travail aboutit a la proposition d’une procedure de discussion de non-readmission en integrant celle-ci dans un reel projet de soins pour le patient a la sortie de reanimation. Ce projet de soins permettrait de prendre l’avis du patient sous forme de directives anticipees « eclairees », de s’assurer d’une discussion collegiale faisant intervenir un consultant exterieur, de permettre une reevaluation du patient dans sa globalite et face a une ou plusieurs defaillances aigues, et d’integrer la question de non-readmission au sein d’un reel projet therapeutique pour le patient en promouvant une eventuelle demarche palliative le cas echeant.

https://dumas.ccsd.cnrs.fr/dumas-01381311/document

Non-réadmissions en réanimation : enquête de pratiques

/pdf/le-medecin-reanimateur-un-consultant-exterieur-pour-un-choix-4yrzqnpz1u.pdf

Le médecin réanimateur : un consultant extérieur pour un choix éclairé du patient et de ses proches ?

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

M. Dion

Author Tools

Chat about Author

Papers

Le médecin réanimateur : un consultant extérieur pour un choix éclairé du patient et de ses proches ?