Family perceptions of clinical research and the informed consent process in the ICU

Abstract Purpose We investigated experiences of families who provide consent for research on behalf of a loved-one hospitalized in intensive care (ICU). Methods Multicentre, qualitative, descriptive study using semi-directive interviews in 3 ICUs. Eligible relatives were aged >18 years, and had provided informed consent for a clinical trial on behalf of a patient hospitalized in ICU. Interviews were conducted from 06/2018 to 06/2019 by a qualified sociologist, recorded and transcribed. Results Fifteen relatives were interviewed; average age 50.3 ± 15 years. All emphasized their interest in clinical research, seeing it as a duty. Involving their loved-one in research allowed them to find mea…

The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person

IF 2.445; International audience; Purpose: In the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate.Methods: We developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs.Results: Amo…

What are the ethical issues in relation to the role of the family in intensive care?

International audience; A large proportion of patients admitted to the intensive care unit (ICU) are unable to express themselves, often due to acute illness, shock or trauma, and this precludes any communication and/or consent for care that might reflect their wishes and opinions. In such cases, the only solution for the ICU physician is to include the patient's family in the healthcare decisions. This can represent a significant burden on the family, on top of the psychological distress of the ICU environment and hospitalisation of their relatives, and many family members may suffer from anxiety, depression or symptoms of post-traumatic stress disorder (PTSD) during or after the hospitali…

Can qualitative research play a role in answering ethical questions in intensive care?

International audience; Scientific and technological progress, as well as increased patient autonomy have profoundly changed the world of healthcare, giving rise to new situations that are increasingly complex and uncertain. Quantitative paradigms, of which the main bastion is evidence-based medicine (EBM), are beginning to reach their limits in daily routine practice of medicine, and new approaches are emerging that can provide novel heuristic perspectives. Qualitative research approaches can be useful for apprehending new areas of knowledge that are fundamental to recent and future developments in intensive care.

How can we best organise communication with patients’ families?

IF 1.542 (2016); International audience

Non-readmission decisions in the intensive care unit: A qualitative study of physicians' experience in a multicentre French study.

Purpose Deciding not to re-admit a patient to the intensive care unit (ICU) poses an ethical dilemma for ICU physicians. We aimed to describe and understand the attitudes and perceptions of ICU physicians regarding non-readmission of patients to the ICU. Materials and methods Multicenter, qualitative study using semi-directed interviews between January and May 2019. All medical staff working full-time in the ICU of five participating centres (two academic and three general, non-academic hospitals) were invited to participate. Participants were asked to describe how they experienced non-readmission decisions in the ICU, and to expand on the manner in which the decision was made, but also on…

What are the ethical dimensions in the profession of intensive care specialist?

International audience; Two essential components of the profession of a medical doctor are the constant review of the patient's therapeutic project, and collaboration between healthcare professionals. The profession of intensive care unit (ICU) physician goes further in terms of responsibility, vis-à-vis the intensive treatments dispensed to the patients, and the physician's responsibilities towards the patient's family and the caregiving team, also bearing in mind that ICU care is costly in terms of human and financial resources. In this review, we address the profession of ICU physician from the perspective of the ethical questions that arise constantly, focusing on the timeframe of the r…

End-of-life situations in cardiology: a qualitative study of physicians' and nurses' experience in a large university hospital.

IF 2.335 (2-year Impact Factor); International audience; Background: rofessional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations.Methods: e performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France. Physicians, nurses and nurses’ aides working full-time in the department at the time of the study were eligible. Participants were asked to describe how they experienc…

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

International audience; 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 ICU…

Intersecting vulnerabilities in professionals and patients in intensive care.

International audience; In the context of healthcare delivery, the vulnerabilities of patients in the intensive care unit (ICU) are intricately linked with those experienced on a daily basis by caregivers in the ICU in a symbiotic relation, whereby patients who are suffering can in turn engender suffering in the caregivers. In the same way, caregivers who are suffering themselves may be a source of suffering for their patients. The vulnerabilities of both patients and caregivers in the ICU are simultaneously constituted through a process that is influenced on the one hand by the healthcare objectives of the ICU, and on the other hand, by the conformity of the patients who are managed in tha…

Mr-Proadm Elevation Upon Icu Admission Predicts the Outcome of Septic Patients and is Correlated with Upcoming Fluid Overload.

IF 3.113; International audience; Background: Among septic patients admitted to the intensive care unit (ICU), early recognition of those with the highest risk of death is of paramount importance. We evaluated the prognostic value of Procalcitonin (PCT), mid regional-proadrenomedullin (MR-proADM), copeptine and CT-proendothelin 1 (CT-ProET 1) concentrations. Methods: This was a prospective cohort study, which included 173 septic patient admitted to one ICU. Blood samples for biomarker measure-ments were obtained upon admission and on day 5. The predictive value of each biomarker regarding the risk of death at day 28 was assessed. The fluid balance was evaluated from admission to day 5. Resu…

Impact psychologique de la pandémie de COVID-19 sur les soignants en réanimation

Alors que l’infection à SARS-COV-2 s’est rapidement propagée au niveau mondial, on a assisté à une mobilisation massive des soignants auprès des personnes infectées. En réanimation, les conditions de travail déjà habituellement difficiles se sont durcies, avec une augmentation forte de la charge de travail, une nécessaire et indispensable réorganisation des soins, des décisions complexes relatives à l’admission des patients et une modification de l’accueil des familles. Le tout dans un climat d’incertitude générale et d’insécurité personnelle. Cet article propose une mise au point sur l’impact psychologique de cette crise sur les soignants en réanimation et les possibles dispositifs d’accom…

What are the characteristics that lead physicians to perceive an ICU stay as non-beneficial for the patient?

Purpose We sought to describe the characteristics that lead physicians to perceive a stay in the intensive care unit (ICU) as being non-beneficial for the patient. Materials and methods In the first step, we used a multidisciplinary focus group to define the characteristics that lead physicians to consider a stay in the ICU as non-beneficial for the patient. In the second step, we assessed the proportion of admissions that would be perceived by the ICU physicians as non-beneficial for the patient according to our focus group’s definition, in a large population of ICU admissions in 4 French ICUs over a period of 4 months. Results Among 1075 patients admitted to participating ICUs during the …

Intensive care unit strain should not rush physicians into making inappropriate decisions, but merely reduce the time to the right decisions being made

The effect of capacity strain in an ICU on the timing of end-of-life decision-making is unknown. We sought to determine how changes in strain impact timing of new do-not-resuscitate (DNR) orders and of death.Retrospective cohort study of 9891 patients dying in the hospital following an ICU stay ≥72 h in Project IMPACT, 2001-2008. We examined the effect of ICU capacity strain (measured by standardized census, proportion of new admissions, and average patient acuity) on time to initiation of DNR orders and time to death for all ICU decedents using fixed-effects linear regression.Increases in strain were associated with shorter time to DNR for patients with limitations in therapy (predicted ti…

What are the ethical aspects surrounding the collegial decisional process in limiting and withdrawing treatment in intensive care?

International audience; The decision to limit or withdraw life-support treatment is an integral part of the job of a physician working in the intensive care unit, and of the approach to care. However, this decision is influenced by a number of factors. It is widely accepted that a medical decision that will ultimate lead to end-of-life in the intensive care unit (ICU) must be shared between all those involved in the care process, and should give precedence to the patient's wishes (either directly expressed by the patient or in written form, such as advance directives), and taking into account the opinion of the patient's family, including the surrogate if the patient is no longer capable of…

Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU

Abstract Purpose We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. Methods Exploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5 days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate. Results In total, 87 relatives of 73 patients…

Impact of a stay in the intensive care unit on the preparation of Advance Directives: Descriptive, exploratory, qualitative study.

Abstract Background Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. Methods The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home > 3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. Results In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of “advance directives”. Only 2% had executed AD before ICU admis…

Une collaboration patient-soignant pour une meilleure prise en charge des troubles cardiovasculaires des personnes ayant des troubles psychiques au long cours

National audience

Impact psychologique de la pandémie de COVID-19 sur les soignants