Michael Darmon1, Guillaume Ducos2, Isaline Coquet2, Matthieu Resche-Rigon3, Frederic Pochard2, Marie Paries2, Nancy Kentish-Barnes2, Marine Chaize2, Benoit Schlemmer4, Elie Azoulay4. 1. Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Etienne, France. Electronic address: michael.darmon@chu-st-etienne.fr. 2. Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 3. Biostatistic Department, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 4. Medical Intensive Care Unit and FAMIREA Study Group, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.
Abstract
BACKGROUND: Surveys have highlighted perceived deficiencies among ICU residents in end-of-life care, symptom control, and confidence in dealing with dying patients. Lack of formal training may contribute to the failure to meet the needs of dying patients and their families. The objective of this study was to evaluate junior intensivists' perceptions of triage and of the quality of the dying process before and after formal academic training. METHODS: Formal training on ethics was implemented as a part of resident training between 2007 and 2012. A cross-sectional survey was performed before (2007) and after (2012) this implementation. This study included 430 junior intensivists who were interviewed during these periods. RESULTS: More responders attended a dedicated training course on ethics and palliative care during 2012 (38.5%) than during 2007 (17.4%; P < .0001). During 2012, respondents reported less discomfort and fewer uncertainties regarding decisions about limiting life-sustaining treatment (17.7% vs 39.1% in 2007; P < .0001) or the triage process (48.5% vs 69.4% in 2007; P < .0001). Factors independently associated with positive perceptions of the dying process were physician's age (OR, 1.19 per year; 95% CI, 1.09-1.25) and male sex (OR, 1.61; 95% CI, 1.05-2.47). Conversely, anxiety about family members' reactions (OR, 0.58; 95% CI, 0.0.37-0.87) and lack of training (OR, 0.29; 95% CI, 0.17-0.50) were associated with negative perceptions of this process. CONCLUSIONS: Formal training dedicated to ethics and palliative care was associated with a more comfortable perception of the dying process. This training may decrease the uncertainty and discomfort of junior intensivists in these situations.
BACKGROUND: Surveys have highlighted perceived deficiencies among ICU residents in end-of-life care, symptom control, and confidence in dealing with dying patients. Lack of formal training may contribute to the failure to meet the needs of dying patients and their families. The objective of this study was to evaluate junior intensivists' perceptions of triage and of the quality of the dying process before and after formal academic training. METHODS: Formal training on ethics was implemented as a part of resident training between 2007 and 2012. A cross-sectional survey was performed before (2007) and after (2012) this implementation. This study included 430 junior intensivists who were interviewed during these periods. RESULTS: More responders attended a dedicated training course on ethics and palliative care during 2012 (38.5%) than during 2007 (17.4%; P < .0001). During 2012, respondents reported less discomfort and fewer uncertainties regarding decisions about limiting life-sustaining treatment (17.7% vs 39.1% in 2007; P < .0001) or the triage process (48.5% vs 69.4% in 2007; P < .0001). Factors independently associated with positive perceptions of the dying process were physician's age (OR, 1.19 per year; 95% CI, 1.09-1.25) and male sex (OR, 1.61; 95% CI, 1.05-2.47). Conversely, anxiety about family members' reactions (OR, 0.58; 95% CI, 0.0.37-0.87) and lack of training (OR, 0.29; 95% CI, 0.17-0.50) were associated with negative perceptions of this process. CONCLUSIONS: Formal training dedicated to ethics and palliative care was associated with a more comfortable perception of the dying process. This training may decrease the uncertainty and discomfort of junior intensivists in these situations.
Authors: Alison E Turnbull; Sarina K Sahetya; E Lee Daugherty Biddison; Christiane S Hartog; Gordon D Rubenfeld; Dominique D Benoit; Bertrand Guidet; Rik T Gerritsen; Mark R Tonelli; J Randall Curtis Journal: Intensive Care Med Date: 2018-07-25 Impact factor: 17.440
Authors: Susan MacDonald; Sarah LeBlanc; Nancy Dalgarno; Karen Schultz; Emily Johnston; Mary Martin; Daniel Zimmerman Journal: Can Fam Physician Date: 2018-09 Impact factor: 3.275