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

Quenot, Jean‐Pierre; Ecarnot, Fiona; Meunier-Beillard, Nicolas; Dargent, Auguste; Large, Audrey; Andreu, Pascal; Rigaud, Jean‐Philippe

doi:10.21037/atm.2017.04.44

Cited by 21 publications

(20 citation statements)

References 55 publications

(45 reference statements)

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“…First is when the clinical course and prognosis seem to be unfavourable in the short term, and then the decision can be made at the end of the patient’s ICU stay in a collective and interdisciplinary approach [ 10 ]. This formal meeting should involve the patient where possible, either directly (if the patient is competent) or via the family and/or surrogate [ 39 ], in order to take account of the choices and preferences expressed by the patient [ 40 ]. Other referring or treating physicians should also be involved where possible in this process to make their contribution to formally establish and ratify the new healthcare project.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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PurposeWe 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 methodsMulticentre 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.ResultsIn total, 167 physicians agreed to participate, of whom 165 (99%) actually returned a completed questionnaire from 58 ICUs. Forty-five percent were aged <35 years, 74% were full-time physicians. The findings show that decisions for non-readmission are taken at the end of the patient’s stay (87%), using a collegial decision-making procedure (89% of cases); 93% reported that this decision was noted in the patient’s medical file. While 73% indicated that the family/relatives were informed of non-readmission decisions, only 29% reported informing the patient, and 91% considered that non-readmission decisions are an integral part of the French legislative framework.ConclusionThis study shows that decisions not to re-admit a patient to the ICU need to be formally materialized, and anticipated by involving the patient and family in the discussions, as well as the other healthcare providers that usually care for the patient. The optimal time to undertake these conversations is likely best decided on a case-by-case basis according to each patient’s individual characteristics.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…For this reason, information must be transmitted using accessible and appropriate language, to meet and respect families' needs. (22) Providers' attitudes, such as educating patients and relatives, increase satisfaction levels, reduce anxiety and improve the relatives' understanding, (6) regardless of the patients' outcomes. (18,21,22) Even in situations of unfavorable clinical progression, communication and support received by the multiprofessional team are the greatest predictors of family satisfaction.…”

Section: ❚ Resultsmentioning

confidence: 99%

Needs of family members of patients in a coronary care unit

Coelho¹,

Lopes²,

Lopes³

et al. 2022

Einstein (São Paulo)

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Objective: To identify the need of family members of patients hospitalized in a coronary intensive care unit and their degree of satisfaction with the care provided. Methods: An observational and cross-sectional study including family members of patients hospitalized in the coronary intensive care unit for acute coronary syndrome in Killip I or II. After the second visit of the same family member to the patient in the unit, a 43-item inventory of needs and stressors of family members was applied. Family members assessed each need for its importance and satisfaction using a four-point Likert scale. The scores in each dimension of importance and satisfaction were compared using the Wilcoxon test, considering a value of p<0.05 as significant. Results: One hundred family members were interviewed. The most important needs were related to assurance and information. Family members had satisfaction scores corresponding to be very satisfied or totally satisfied, but with lower scores when compared to the needs scores (p<0.01). Conclusion: The most important needs of family members of patients hospitalized in the coronary intensive care unit were related to assurance and information. Multiprofessional interventions involving better communication of patient information to family members should be incorporated into the coronary intensive care unit.

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“…Furthermore, nursing staff are often more realistic than the physicians with regard to a clinical situation, especially as regards loss of autonomy for the patient. In any case, it is the physician’s duty to provide clear, transparent and honest information to the patient and family [ 44 ]. Nonetheless, it should be noted that informing a patient who is in a situation of vulnerability, even about the fact that non-readmission to the ICU was discussed, can be particularly impactful.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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 the traceability and timing of the decision. Interviews were recorded, transcribed and analyzed using textual content analysis. Results In total, 22 physicians participated. Interviews lasted on average 26±7 minutes. There were 14 men and 8 women, average age was 35±9 years, and average length of ICU experience was 7±5 years. The majority of respondents said that they regretted that the question of non-readmission was not addressed before the initial ICU admission. They acknowledged that the ICU stay did lead to more thorough contemplation of the overall goals of care. Multidisciplinary team meetings could help to anticipate the question of readmission within the patient’s care pathway. Participants reported that there is a culture of collegial decision-making in the ICU, although the involvement of patients, families and other healthcare professionals in this process is not systematic. The timing and traceability of non-readmission decisions are heterogeneous. Conclusions Non-readmission decisions are a major issue that raises ethical questions surrounding the fact that there is no discussion of the patient’s goals of care in advance. Better anticipation, and better communication with the patients, families and other healthcare providers are suggested as areas that could be targeted for improvement.

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

Cited by 21 publications

References 55 publications

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

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

Needs of family members of patients in a coronary care unit

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

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