L’information dans le contexte du soin périnatal : aspects éthiques

Azria, Élie; Bétrémieux, P.; Caeymaex, Laurence; Debillon, T.; Fournié, A; Huillery, M.-L.; Kuhn, Pierre; Lequien, P; Altavilla, Annagrazia; Michelet, Dominique

doi:10.1016/j.gyobfe.2008.02.014

Cited by 10 publications

(4 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The full range of options, including fetal intervention, postnatal therapy, palliative care, or pregnancy termination, should be discussed". French guidelines also contributed to the content of this discussion [ 6 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…There has been much work published on strategies for managing pregnancies with lethal fetal abnormalities based on the expert opinions [ 6 – 11 ]. While many "recommendations" advise what perinatal professionals should do [ 6 ], there is only little data on what professionals actually do in practice. It is therefore important that multidisciplinary teams analyze and evaluate their professional practices.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Barriers in Referring Neonatal Patients to Perinatal Palliative Care: A French Multicenter Survey

et al. 2015

View full text Add to dashboard Cite

BackgroundWhen an incurable fetal condition is detected, some women (or couples) would rather choose to continue with the pregnancy than opt for termination of pregnancy for medical reasons, which, in France, can be performed until full term. Such situations are frequently occurring and sometimes leading to the implementation of neonatal palliative care. The objectives of this study were to evaluate the practices of perinatal care french professionals in this context; to identify the potential obstacles that might interfere with the provision of an appropiate neonatal palliative care; and, from an opposite perspective, to determine the criteria that led, in some cases, to offer this type of care for prenatally diagnosed lethal abnormality.MethodsWe used an email survey sent to 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) at 48 multidisciplinary centers for prenatal diagnosis (MCPD).ResultsForty-two multidisciplinary centers for prenatal diagnosis (87.5%) took part. In total, 102 MFMs and 112 FCPs completed the survey, yielding response rate of 49.3%. One quarter of professionals (26.2%) estimated that over 20% of fetal pathologies presenting in MCPD could correspond to a diagnosis categorized as lethal (FCPs versus MFMs: 24% vs 17.2%, p = 0.04). The mean proportion of fetal abnormalities eligible for palliative care at birth was estimated at 19.30% (± 2.4) (FCPs versus MFMs: 23.4% vs 15.2%, p = 0.029). The degree of diagnostic certainty appears to be the most influencing factor (98.1%, n = 207) in the information provided to the pregnant woman with regard to potential neonatal palliative care. The vast majority of professionals, 92.5%, supported considering the practice of palliative care as a regular option to propose antenatally.ConclusionsOur study reveals the clear need for training perinatal professionals in perinatal palliative care and for the standardization of practices in this field.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers in Referring Neonatal Patients to Perinatal Palliative Care: A French Multicenter Survey

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Nevertheless, Cremer et al [28] have noted certain weaknesses concerning the transmission of such medical information, which for example does not enable exchange between the professionals concerned. From the beginning of the pediatric care process, parental advice is increasingly collected [25, 27, 29–31]; parents thus act as spokespeople and protectors of the best interest of their child (to assert autonomy). Encouraging the parents to express themselves and integrating them into the healthcare process guarantees trust and strengthens their sense of parenthood.…”

Section: Discussionmentioning

confidence: 99%

Formal procedure to facilitate the decision to withhold or withdraw life-sustaining interventions in a neonatal intensive care unit: a seven-year retrospective study

2018

View full text Add to dashboard Cite

BackgroundNeonatal deaths are often associated with the complex decision to limit or withdraw life-sustaining interventions (LSIs) rather than therapeutic impasses. Despite the existence of a law, significant disparities in clinical procedures remain. This study aimed to assess deaths occurring in a Neonatal Intensive Care Unit (NICU) and measure the impact of a traceable Limitation or Withdrawal of Active Treatment (LWAT) file on the treatment of these newborns.MethodsIn this monocentric retrospective study, we reviewed all consecutive neonatal deaths occurring during two three-year periods among patients in the NICU at the North Hospital of Marseille: cohort 1 (from 2009 to 2011 without the LWAT file) and cohort 2 (from 2013 to 2015 after introduction of the LWAT file). Newborns included were: gestational age over 22 weeks, birth weight over 500 g, and admission and death in the same NICU. Deaths were categorized according to the classification described by Verhagen et al.: 1) children who died despite cardiopulmonary resuscitation (CPR) (no withholding nor withdrawing of LSIs), (2) children who died while the ventilator, without CPR (no withdrawing of LSIs, but CPR withheld), (3) children who died after LSIs were withdrawn, or (4) LSIs were withheld.Results193 deaths were analyzed: 77 in cohort 1 and 116 in cohort 2. 50% of deaths followed the decision to limit or stop life-sustaining interventions. The mean age at death did not differ between the two cohorts (p = 0.525). An increase in the mortality rate after life-sustaining interventions were withdrawn was observed. The number of multidisciplinary decision meetings was statistically higher in cohort 2 (32.5% versus 55.2% p = 0.002), which were most often prompted due to neurological pathologies, with an increase in parental advice concerning the management of their child (p = 0.026). Even if the introduction of this file did not have an effect on patient age at death, it was significantly associated with a better understanding of end-of-life conditions (p = 0.019), including medication used to sedate and comfort the patient.ConclusionsIntroduction of the LWAT file seems imperative to develop a personalized healthcare strategy for each child and situation.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0329-x) contains supplementary material, which is available to authorized users.

show abstract

“…Ailleurs, le médecin est de plus en plus tenu de donner une information loyale, claire et appropriée, hormis les cas d'urgence, d'impossibilité ou de refus du patient d'être informé [14]. En premier lieu, cette information est due au père et à la mère [15], ce à quoi nous devons songer dans notre pratique africaine, tout en ménageant les susceptibilités.…”

Section: Droit Du Patient Et Obligation Du Médecinunclassified

Information médicale et malformations néonatales en Côte d’Ivoire

Lasme-Guillao

2013

Médecine Palliative : Soins de Support - Accompagnement - Éthiq

View full text Add to dashboard Cite

L’information dans le contexte du soin périnatal : aspects éthiques

Cited by 10 publications

References 7 publications

Barriers in Referring Neonatal Patients to Perinatal Palliative Care: A French Multicenter Survey

Barriers in Referring Neonatal Patients to Perinatal Palliative Care: A French Multicenter Survey

Formal procedure to facilitate the decision to withhold or withdraw life-sustaining interventions in a neonatal intensive care unit: a seven-year retrospective study

Information médicale et malformations néonatales en Côte d’Ivoire

Contact Info

Product

Resources

About