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

2003; American Thoracic Society; Volume: 167; Issue: 10 Linguagem: Inglês

10.1164/rccm.200207-752oc

1535-4970

Édouard Ferrand, François Lemaire, B. Régnier, Khaldoun Kuteifan, Michel Badet, Pierre Asfar, Samir Jaber, Jean-Luc Chagnon, Anne Renault, R. Robert, Frédéric Pochard, Christian Hervé, Christian Brun‐Buisson, Philippe Duvaldestin,

Ethics in medical practice

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.