Decision Making
Conditions
Keywords
Intensive care unit, Triage and Therapy., Advance Directives (AD)., Simulation model of real situations. (hypothetical scenario), Intensivist physician.
Brief summary
A new law about the advance directives (AD) has been recently voted in France on February 2, 2016. This Claeys-Leonetti law has made the AD more binding, as in other countries. This should lead to a greater respect of the human autonomy principle. However, the interpretation of these guidelines is often difficult and may differ between doctors. Indeed, the subjectivity of these interpretations could lead to different medical decisions by physicians. The investigators intend to assess the effect of advance directives (AD) on decision making in care by intensivists, using a simulated (hypothetical) situation.
Detailed description
Observational simulation (hypothetical) study of intensivist decisions for selected real patients. Each patient writes advance directives (AD) after receiving clear information (videos and interview with an independent intensivist). Intensivists answer to 5 questions for two simulations (hypothetical) models (scenario) on pneumonia and occlusive syndrome, in 3 times: without the AD, with AD, and with AD by knowing the drafting conditions (information from intensivist).
Interventions
PROCEDUREDecision making for ICU patients' care
Study of factors involved in the decision-making for ICU patients' care. Effect of advance directives (AD).
Sponsors
University Hospital, Clermont-Ferrand
Study design
Observational model
OTHER
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Inclusion criteria for patients : * 20 patients with chronic diseases or 80 years old patient or older, * 4 patients with chronic cardiac failure challenged in heart transplant * 4 patients with chronic renal failure challenged in kidney transplant * 4 COPD patients in terminal stage * 4 patients with lung cancer challenged in surgery * 4 patients, 80 years old or older, without cognitive impairment Inclusion criteria for physician : * Working in Intensive Care Unit (ICU) * From the 10 ICUs involved in the protocol
Exclusion criteria
*
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intensivists's answers to 5 questions for the 2 scenarios for each of the 20 patients | at day 1 | Intensivists's answers to 5 questions for the 2 scenarios for each of the 20 patients, in 3 times: without AD first, then with AD and AD with knowing they were made with an intensivist, in this order |
Secondary
| Measure | Time frame |
|---|---|
| Comparison of answers to 5 questions for the 2 scenarios for each of the 20 patients between the 3 scenarios submission time for each intensivist (intra-individual variability). | at day 1 |
| Comparison for each question | at day 1 |
| Assessment of the concordance between the AD and the intensivists's answers. Direct comparison for objective criteria (organ replacement) between the patients's AD and intensivists's answers. And expert opinion for subjective criteria | at day 1 |
| Drafting time for the realization of the AD | at day 1 |
Countries
France
Outcome results
None listed