An Interprofessional Process for the Limitation of Life-Sustaining Treatments at the End of Life in France

Blythe, Jacob A.; Kentish‐Barnes, Nancy; Debue, Anne-Sophie; Dohan, Daniel; Azoulay, Élie; Covinsky, Ken; Matthews, Thomas L.; Curtis, J. Randall; Dzeng, Elizabeth

doi:10.1016/j.jpainsymman.2021.06.016

Cited by 13 publications

(22 citation statements)

References 42 publications

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“…This shows that critical care nurses are equipped with fundamental knowledge of end-of-life care and understand that teamwork with other healthcare professionals in the end-oflife care team is important. Other research suggested that interprofessional interventions and interdisciplinary teamwork have the potential to support ICU staff to provide better end-of-life care [12][13][14]. The least familiar item among critical care nurses was about laws relating to end-of-life care, which referred to the Hospice Palliative Care Act in Taiwan [1].…”

Section: Discussionmentioning

confidence: 99%

Critical care nurses’ knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care

Liu

Joo

et al. 2022

BMC Nurs

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Background End-of-life care can be a difficult and challenging process for critical care nurses in intensive care units (ICUs) due to the care plan shifts from providing life-sustaining measures to end-of-life care. The aims of this study were to assess critical care nurses' perceived knowledge and attitudes toward end-of-life care, as well as their perspectives on promoting advance directives and the associated factors. Methods A cross-sectional study was undertaken in an acute major metropolitan medical center in northern Taiwan between February and March 2020, and 250 critical care nurses were invited to participate in the study. Data on demographics, self-perceived knowledge of end-of-life care, attitudes toward end-of-life care, and perspectives of promoting advance directives were collected. A multiple linear regression model with stepwise selection was used to identify factors associated with their perspectives of promoting advance directives. Results The law related to end-of-life care was rated as the least familiar part of the self-perceived end-of-life care knowledge, while ‘I have sufficient knowledge to care for patients who have accepted end-of-life care’ was the lowest level of agreement in attitude scores among critical care nurses. Increased levels of perceived knowledge (β = 0.134; p = 0.045) and attitudes (β = 0.423; p < 0.001) toward end-of-life care were associated with the perspectives of promoting advance directives. Nurses who worked in cardiac (β = -0.234; p < 0.001) and respiratory ICUs (β = -0.135; p = 0.024) had less motivation to promote advance directives (F = 16.943; p < 0.001). Conclusion Given their important contributions to ICU care services, appropriate and meaningful support is required to optimize critical care nurses' involvement in end-of-life care. This study demonstrated a significant impact on perspectives of promoting advance directives of critical care nurse participants. Findings from this study can inform the design of effective nurse support programs to enhance the promotion of advance directives in intensive care settings.

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Section: Discussionmentioning

confidence: 99%

Critical care nurses’ knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care

Liu

Joo

et al. 2022

BMC Nurs

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“…5 Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, WA, USA. 6 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

“…These policies often increase the permissibility of limitations of life-sustaining treatment and provide clarity and transparency around the process through which these decisions are made. An example of this type of policy is France’s Leonetti law (2005), which focused on improving interprofessional communication about withdrawing or withholding of life-sustaining treatment during terminal illness [ 6 ]. Leonetti’s law created an explicit collegial interprofessional process for establishing consensus around limitations of non-beneficial life-sustaining treatment.…”

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confidence: 99%

“…Leonetti’s law created an explicit collegial interprofessional process for establishing consensus around limitations of non-beneficial life-sustaining treatment. In a qualitative study of French ICU clinicians following the passage of Leonetti’s Law, this interprofessional process was found to facilitate a more ethical climate around end-of-life decision-making, where discussions around treatment decisions shifted from hushed discussions to more openness and transparency [ 6 ]. Nurses felt more empowered to participate in end-of-life decision-making, thus reducing moral distress and clinicians felt they were better able to maintain a unified message with patients and families.…”

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confidence: 99%

“…Policy makers and clinicians must work together to create policies that promote ethical decision-making while refraining from overly restrictive policies that can be harmful to high-quality and ethical end-of-life care. The experiences in France [ 6 ] and South Korea [ 2 ] suggest that policy interventions have the power to change the culture around end-of-life care for the better.…”

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confidence: 99%

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The role of policy and law in shaping the ethics and quality of end-of-life care in intensive care

Dzeng

Bein²,

Curtis

2022

Intensive Care Med

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Hospital Culture and Intensity of End-of-Life Care at 3 Academic Medical Centers

Dzeng

Batten

Dohan³

et al. 2023

JAMA Intern Med

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ImportanceThere is substantial institutional variability in the intensity of end-of-life care that is not explained by patient preferences. Hospital culture and institutional structures (eg, policies, practices, protocols, resources) might contribute to potentially nonbeneficial high-intensity life-sustaining treatments near the end of life.ObjectiveTo understand the role of hospital culture in the everyday dynamics of high-intensity end-of-life care.Design, Setting, and ParticipantsThis comparative ethnographic study was conducted at 3 academic hospitals in California and Washington that differed in end-of-life care intensity based on measures in the Dartmouth Atlas and included hospital-based clinicians, administrators, and leaders. Data were deductively and inductively analyzed using thematic analysis through an iterative coding process.Main Outcome and MeasureInstitution-specific policies, practices, protocols, and resources and their role in the everyday dynamics of potentially nonbeneficial, high-intensity life-sustaining treatments.ResultsA total of 113 semistructured, in-depth interviews (66 women [58.4%]; 23 [20.4%] Asian, 1 [0.9%] Black, 5 [4.4%] Hispanic, 7 [6.2%] multiracial, and 70 [61.9%] White individuals) were conducted with inpatient-based clinicians and administrators between December 2018 and June 2022. Respondents at all hospitals described default tendencies to provide high-intensity treatments that they believed were universal in US hospitals. They also reported that proactive, concerted efforts among multiple care teams were required to deescalate high-intensity treatments. Efforts to deescalate were vulnerable to being undermined at multiple points during a patient’s care trajectory by any individual or entity. Respondents described institution-specific policies, practices, protocols, and resources that engendered broadly held understandings of the importance of deescalating nonbeneficial life-sustaining treatments. Respondents at different hospitals reported different policies and practices that encouraged or discouraged deescalation. They described how these institutional structures contributed to the culture and everyday dynamics of end-of-life care at their institution.Conclusions and RelevanceIn this qualitative study, clinicians, administrators, and leaders at the hospitals studied reported that they work in a hospital culture in which high-intensity end-of-life care constitutes a default trajectory. Institutional structures and hospital cultures shape the everyday dynamics by which clinicians may deescalate end-of-life patients from this trajectory. Individual behaviors or interactions may fail to mitigate potentially nonbeneficial high-intensity life-sustaining treatments if extant hospital culture or a lack of supportive policies and practices undermine individual efforts. Hospital cultures need to be considered when developing policies and interventions to decrease potentially nonbeneficial, high-intensity life-sustaining treatments.

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An Interprofessional Process for the Limitation of Life-Sustaining Treatments at the End of Life in France

Cited by 13 publications

References 42 publications

Critical care nurses’ knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care

Critical care nurses’ knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care

The role of policy and law in shaping the ethics and quality of end-of-life care in intensive care

Hospital Culture and Intensity of End-of-Life Care at 3 Academic Medical Centers

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