Criteria of Vulnerability
Conditions
Keywords
Leonetti law, palliative care
Brief summary
Rationale: Medicalized end of life rose profound society questions and debates. Major Laws and scientific society recommendations emerged from those reflections. These texts help withholding/withdrawing life-sustaining treatments allowing a palliative approach and to favor comfort treatments for end of life patients. Main Objective: To evaluate the impact of a procedure to support reflection on the level of therapeutic involvement for surgical patient (who undergone surgery or not) in ICU after having identified vulnerability criteria early. Secondary objectives: To assess the usual care of the control group and the impact of the procedure according to ICU type (medical, surgical, mixed); the characteristics of surgical patients concerned by a palliative strategy; the impact of an incentive approach on length of mechanical ventilation and length of stay in the ICU; To measure the extent of information collected concerning the collegial process; the impact of the procedure on caregivers' satisfaction; To count the number of identified conflicts Study type: Prospective, controlled, cluster randomized study of routine care Purpose: Study the implementation of the Act Leonetti released on 22 April 2005 calling for a compassionate approach and palliative care for patients at end of life. Inclusion criteria: Surgical patients (who undergone surgery or not) hospitalized in ICU during the study period Non-inclusion criteria: Patients hospitalized less than 24h; non-surgical patients; patients who don't need ICU care or surveillance; minors; brain-dead patients (at the time of admission) Primary endpoint: Rate of deaths with palliative strategy (withholding or withdrawing treatments) Randomization process: each center is randomized adjusting on type of ICU (medical, surgical, mixed) and number of annual hospitalization volume. * Control group: ICU usual care * Intervention group: vulnerability criteria lead to reflection on level of therapeutic involvement, with the help of a written guide. Number of patients: 2750 surgical patients Number of centers: 45 Study design: usual data will be collected in a secured web-based Case Report Form (CRF) at ICU admission and each time therapeutic strategy will change. Additional data will be collected for the intervention group according to the initial presence or the later apparition of predefined criteria, a standardized reflection procedure will start helped by the implementation of a guide for collegial approach and decision making. Length: 30 months
Interventions
OTHERstrategy promoting early consideration and collegiate vulnerability of patients
One day training with the provision of vulnerability criteria inciting an early reflection of the level of therapeutic engagement; sheets available on the internet computer support collegial reflection and traceability of decisions to limit and stop treatments, incorporating the provisions of law known Leonetti
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Surgical patients (who undergone surgery or not) hospitalized in ICU during the study period * No opposition to the use of data collected from the patient or a relative or inclusion in emergency and non-opposition collected offline
Exclusion criteria
* Patients admitted legally dead or brain-dead
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants dead with palliative strategy | From ICU hospitalization to 6 months after inclusion | Rate of death with collegial process and withdrawing/withholding treatment |
Secondary
| Measure | Time frame |
|---|---|
| Characteristics of surgical patients concerned by a palliative strategy | From ICU hospitalization to 6 months after inclusion |
| Impact of an incentive approach on length of mechanical ventilation and length of stay in the ICU. | From ICU hospitalization to 6 months after inclusion |
| Impact of the procedure according to ICU type | From ICU hospitalization to 6 months after inclusion |
| Impact of the procedure on caregivers' satisfaction | From ICU hospitalization to 6 months after inclusion |
| Number of identified conflicts | From ICU hospitalization to 6 months after inclusion |
| Extent of information collected concerning the collegial process | From ICU hospitalization to 6 months after inclusion |
Countries
France
Outcome results
None listed