help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Published ahead of print on January 24, 2003, doi:10.1164/rccm.200207-752OC
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online Supplement
Right arrow All Versions of this Article:
200207-752OCv1
167/10/1310    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ferrand, E.
Right arrow Articles by Duvaldestin, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ferrand, E.
Right arrow Articles by Duvaldestin, P.
American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 1310-1315, (2003)
© 2003 American Thoracic Society

Discrepancies between Perceptions by Physicians and Nursing Staff of Intensive Care Unit End-of-Life Decisions

Edouard Ferrand, François Lemaire, Bernard Regnier, Khaldoun Kuteifan, Michel Badet, Pierre Asfar, Samir Jaber, Jean-Luc Chagnon, Anne Renault, René Robert, Frédéric Pochard, Christian Herve, Christian Brun-Buisson and Philippe Duvaldestin, for the French RESSENTI Group

Réanimation Chirurgicale, Hôpital Henri Mondor; Réanimation Médicale, Hôpital Universitaire Henri Mondor, AP-HP, Créteil; Laboratoire d'Ethique Médicale et de Santé Publique, Hôpital Necker Enfants-Malades; Réanimation Médicale, Hôpital Universitaire Bichat-Claude Bernard; Réanimation Médicale, Hôpital Universitaire Cochin, AP-HP, Paris; Réanimation Médicale, Hôpital La Source, Orléans; Réanimation Médicale, Hôpital Universitaire La Croix Rousse, Lyon; Réanimation Médicale, Centre Hospitalier Universitaire, Angers; Réanimation Chirurgicale, DAR B, Hôpital Universitaire Saint-Eloi, Montpellier; Réanimation Polyvalente, Centre Hospitalier Général, Valenciennes; Réanimation Médicale, Hôpital Universitaire de la Cavale Blanche, Brest; and Réanimation Médicale, Hôpital Universitaire Jean Bernard, Poitiers, France

Correspondence and requests for reprints should be addressed to Edouard Ferrand, Service d'Anesthésie-Réanimation, Unité de Réanimation Chirurgicale et Traumatologique, Hôpital Henri-Mondor, AP-HP, 51 rue du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. E-mail: edouard.ferrand{at}hmn.ap-hop-paris.fr

Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.

Key Words: end-of-life decisions • ethics • decision-making • critical care • intensive care




This article has been cited by other articles:


Home page
 Nurs EthicsHome page
E. Haggstrom, E. Mbusa, and B. Wadensten
Nurses' Workplace Distress and Ethical Dilemmas in Tanzanian Health Care
Nursing Ethics, July 1, 2008; 15(4): 478 - 491.
[Abstract] [PDF]

Home page
 Arch Intern MedHome page
E. Ferrand, P. Jabre, C. Vincent-Genod, R. Aubry, M. Badet, P. Badia, A. Cariou, F. Ellien, V. Gounant, R. Gil, et al.
Circumstances of Death in Hospitalized Patients and Nurses' Perceptions: French Multicenter Mort-a-l'Hopital Survey
Arch Intern Med, April 28, 2008; 168(8): 867 - 875.
[Abstract] [Full Text] [PDF]

Home page
 Nurs EthicsHome page
M. Silen, M. Svantesson, and G. Ahlstrom
Nurses' Conceptions of Decision Making Concerning Life-Sustaining Treatment
Nursing Ethics, March 1, 2008; 15(2): 160 - 173.
[Abstract] [PDF]

Home page
 CMAJHome page
R. Sibbald MSc, J. Downar MD, and L. Hawryluck MD MSc
Perceptions of "futile care" among caregivers in intensive care units
Can. Med. Assoc. J., November 6, 2007; 177(10): 1201 - 1208.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
C. Schmalenberg and M. Kramer
Types of Intensive Care Units With the Healthiest, Most Productive Work Environments
Am. J. Crit. Care., September 1, 2007; 16(5): 458 - 468.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
S. Nava, C. Sturani, S. Hartl, G. Magni, M. Ciontu, A. Corrado, A. Simonds, and on behalf of the European Respiratory Society Task
End-of-life decision-making in respiratory intermediate care units: a European survey
Eur. Respir. J., July 1, 2007; 30(1): 156 - 164.
[Abstract] [Full Text] [PDF]

Home page
 J. Med. EthicsHome page
C O Sham, Y W Cheng, K W Ho, P H Lai, L W Lo, H L Wan, C Y Wong, Y N Yeung, S H Yuen, and A Y C Wong
Do-not-resuscitate decision: the attitudes of medical and non-medical students
J. Med. Ethics, May 1, 2007; 33(5): 261 - 265.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. C. Poncet, P. Toullic, L. Papazian, N. Kentish-Barnes, J.-F. Timsit, F. Pochard, S. Chevret, B. Schlemmer, and E. Azoulay
Burnout Syndrome in Critical Care Nursing Staff
Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 698 - 704.
[Abstract] [Full Text] [PDF]

Home page
 J. Med. EthicsHome page
E Ferrand, P Jabre, S Fernandez-Curiel, F Morin, C Vincent-Genod, P Duvaldestin, F Lemaire, C Herve, and J Marty
Participation of French general practitioners in end-of-life decisions for their hospitalised patients
J. Med. Ethics, December 1, 2006; 32(12): 683 - 687.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
L. Downey, R. A. Engelberg, S. E. Shannon, and J. R. Curtis
Measuring Intensive Care Nurses' Perspectives on Family-Centered End-of-Life Care: Evaluation of 3 Questionnaires
Am. J. Crit. Care., November 1, 2006; 15(6): 568 - 579.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
D. Cook, G. Rocker, J. Marshall, L. Griffith, E. McDonald, G. Guyatt, and for the Level of Care Study Investigators and the
Levels of Care in the Intensive Care Unit: A Research Program
Am. J. Crit. Care., May 1, 2006; 15(3): 269 - 279.
[Abstract] [Full Text] [PDF]

Home page
 Nurs EthicsHome page
M. Svantesson, P. Sjokvist, H. Thorsen, and G. Ahlstrom
Nurses' and Physicians' Opinions on Aggressiveness of Treatment for General Ward Patients
Nursing Ethics, March 1, 2006; 13(2): 147 - 162.
[Abstract] [PDF]

Home page
 ChestHome page
A. Garland
Improving the ICU: Part 2
Chest, June 1, 2005; 127(6): 2165 - 2179.
[Abstract] [Full Text] [PDF]

Home page
 J. Med. EthicsHome page
M Guedj, M Gibert, A Maudet, M T Munoz Sastre, E Mullet, and P C Sorum
The acceptability of ending a patient's life
J. Med. Ethics, June 1, 2005; 31(6): 311 - 317.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. R. Levy, E. W. Ely, K. Payne, R. A. Engelberg, D. L. Patrick, and J. R. Curtis
Quality of Dying and Death in Two Medical ICUs: Perceptions of Family and Clinicians
Chest, May 1, 2005; 127(5): 1775 - 1783.
[Abstract] [Full Text] [PDF]

Home page
 Chronic Respiratory DiseaseHome page
J-L Vincent, J Berre, and J Creteur
Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective
Chronic Respiratory Disease, April 1, 2004; 1(2): 115 - 120.
[Abstract] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
Critical Care Medicine in AJRCCM 2003
Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 239 - 253.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. H. Morris
Perceptions, Confessions: A Systems Response Is Needed
Am. J. Respir. Crit. Care Med., May 15, 2003; 167(10): 1302 - 1303.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2003 American Thoracic Society