Pascal Andreu1, Auguste Dargent2, Audrey Large1, Nicolas Meunier-Beillard3, Sandrine Vinault4, Uriel Leiva-Rojas1, Fiona Ecarnot5, Sébastien Prin1, Pierre-Emmanuel Charles2, Isabelle Fournel4, Jean-Philippe Rigaud6, Jean-Pierre Quenot7. 1. Service de réanimation médicale, université de Bourgogne-Franche-Comté, CHU de Dijon, Dijon, France. 2. Service de réanimation médicale, université de Bourgogne-Franche-Comté, CHU de Dijon, Dijon, France; LipnessTeam, Inserm, UMR866, université de Bourgogne-Franche-Comté, Dijon, France. 3. Service de réanimation médicale, université de Bourgogne-Franche-Comté, CHU de Dijon, Dijon, France; Centre Georges-Chevrier, UMR 7366 CNRS, université de Bourgogne-Franche-Comté, Dijon, France. 4. Inserm CIC 1432, faculté de médecine de Dijon, université de Bourgogne-Franche-Comté, Dijon, France. 5. EA3920, département de cardiologie, université de Bourgogne-Franche-Comté, Besançon, France. 6. Service de réanimation polyvalente, centre hospitalier de Dieppe, Dieppe, France. 7. Service de réanimation médicale, université de Bourgogne-Franche-Comté, CHU de Dijon, Dijon, France; LipnessTeam, Inserm, UMR866, université de Bourgogne-Franche-Comté, Dijon, France; Inserm CIC 1432, faculté de médecine de Dijon, université de Bourgogne-Franche-Comté, Dijon, France. Electronic address: jean-pierre.quenot@chu-dijon.fr.
Abstract
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. METHODS: The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home>3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. RESULTS: In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of "advance directives". Only 2% had executed AD before ICU admission, and 7% expressed a desire to prepare AD further to their ICU stay. Among the barriers to preparation of AD, lack of information was the main reason cited for not executing AD. Patients noted the following in their AD: withdrawal of life-support in case of vegetative/minimally conscious state or when there is no longer any hope, in case of uncontrollable pain, and if impossible to wean from mechanical ventilation. CONCLUSION: The ideal time to engage patients in these discussions is most likely well before an acute health event occurs, although this warrants further investigation both before and after ICU admissions.
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. METHODS: The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home>3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD. RESULTS: In total, among 159 eligible patients, data from 94 (59%) were available for analysis. Among all those interviewed, 83.5% had never heard of "advance directives". Only 2% had executed AD before ICU admission, and 7% expressed a desire to prepare AD further to their ICU stay. Among the barriers to preparation of AD, lack of information was the main reason cited for not executing AD. Patients noted the following in their AD: withdrawal of life-support in case of vegetative/minimally conscious state or when there is no longer any hope, in case of uncontrollable pain, and if impossible to wean from mechanical ventilation. CONCLUSION: The ideal time to engage patients in these discussions is most likely well before an acute health event occurs, although this warrants further investigation both before and after ICU admissions.
Authors: Linda H Phung; Deborah E Barnes; Aiesha M Volow; Brookelle H Li; Nikita R Shirsat; Rebecca L Sudore Journal: J Am Geriatr Soc Date: 2021-06-01 Impact factor: 7.538