Assessment of Factors Involved in the Decision-making for ICU Patients' Care

University Hospital, Clermont-Ferrand20 enrolled

Overview

A new law about the advance directives (AD) has been recently voted in France on February 2, 2016. This " Claeys-Leonetti " law has made the AD more binding, as in other countries. This should lead to a greater respect of the human autonomy principle. However, the interpretation of these guidelines is often difficult and may differ between doctors. Indeed, the subjectivity of these interpretations could lead to different medical decisions by physicians. The investigators intend to assess the effect of advance directives (AD) on decision making in care by intensivists, using a simulated (hypothetical) situation.

Observational simulation (hypothetical) study of intensivist decisions for selected real patients. Each patient writes advance directives (AD) after receiving clear information (videos and interview with an independent intensivist). Intensivists answer to 5 questions for two simulations (hypothetical) models (scenario) on pneumonia and occlusive syndrome, in 3 times: without the AD, with AD, and with AD by knowing the drafting conditions (information from intensivist).

Study Type

OBSERVATIONAL

Enrollment

Conditions

Decision Making

Interventions

Decision making for ICU patients' care

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Inclusion criteria for patients : * 20 patients with chronic diseases or 80 years old patient or older, * 4 patients with chronic cardiac failure challenged in heart transplant * 4 patients with chronic renal failure challenged in kidney transplant * 4 COPD patients in terminal stage * 4 patients with lung cancer challenged in surgery * 4 patients, 80 years old or older, without cognitive impairment Inclusion criteria for physician : * Working in Intensive Care Unit (ICU) * From the 10 ICUs involved in the protocol Exclusion Criteria: * Exclusion criteria for physician : * Decline to participate

Outcomes

Primary Outcomes

Intensivists's answers to 5 questions for the 2 scenarios for each of the 20 patients

Intensivists's answers to 5 questions for the 2 scenarios for each of the 20 patients, in 3 times: without AD first, then with AD and AD with knowing they were made with an intensivist, in this order

Time frame: at day 1

Secondary Outcomes

Comparison of answers to 5 questions for the 2 scenarios for each of the 20 patients between the 3 scenarios submission time for each intensivist (intra-individual variability).

Time frame: at day 1

Comparison for each question

Time frame: at day 1

Assessment of the concordance between the AD and the intensivists's answers. Direct comparison for objective criteria (organ replacement) between the patients's AD and intensivists's answers. And expert opinion for subjective criteria

Time frame: at day 1

Drafting time for the realization of the AD

Time frame: at day 1

Assessment of Factors Involved in the Decision-making for ICU Patients' Care

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes