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Assessing physicians' and nurses' experience of dying and death in the ICU: development of the CAESAR-P and the CAESAR-N instruments.
Boissier, Florence; Seegers, Valérie; Seguin, Amélie; Legriel, Stéphane; Cariou, Alain; Jaber, Samir; Lefrant, Jean-Yves; Rimmelé, Thomas; Renault, Anne; Vinatier, Isabelle; Mathonnet, Armelle; Reuter, Danielle; Guisset, Olivier; Cracco, Christophe; Durand-Gasselin, Jacques; Éon, Béatrice; Thirion, Marina; Rigaud, Jean-Philippe; Philippon-Jouve, Bénédicte; Argaud, Laurent; Chouquer, Renaud; Papazian, Laurent; Dedrie, Céline; Georges, Hugues; Lebas, Eddy; Rolin, Nathalie; Bollaert, Pierre-Edouard; Lecuyer, Lucien; Viquesnel, Gérald; Leone, Marc; Chalumeau-Lemoine, Ludivine; Garrouste-Orgeas, Maité; Azoulay, Elie; Kentish-Barnes, Nancy.
Afiliación
  • Boissier F; Medical Intensive Care, University Hospital of Poitiers, Poitiers, France.
  • Seegers V; INSERM CIC 1402 (ALIVE group), Poitiers University, Poitiers, France.
  • Seguin A; Data Management Research Department DRCI, Angers Hospital and SFR ICAT, University of Angers, Angers, France.
  • Legriel S; Medical Intensive Care, Caen University Hospital, Caen, France.
  • Cariou A; Intensive Care, Versailles Hospital, Versailles, France.
  • Jaber S; Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Cochin University Hospital, Paris, France.
  • Lefrant JY; Paris Descartes University, Paris, France.
  • Rimmelé T; Saint Eloi Hospital, Centre Hospitalier Universitaire Montpellier, Anesthesia and Critical Care Department B, Montpellier, France.
  • Renault A; PhyMedExp, University of Montpellier, Montpellier, France.
  • Vinatier I; INSERM U1046, CNRS UMR 9214, Montpellier, France.
  • Mathonnet A; Anesthesia and Intensive Care, Carémeau University Hospital, Nîmes, France.
  • Reuter D; Nîmes University, Nîmes, France.
  • Guisset O; Anaesthesia and Intensive Care Medicine, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.
  • Cracco C; University Claude Bernard Lyon 1, Lyon, France.
  • Durand-Gasselin J; Medical Intensive Care, Cavale Blanche University Hospital, Brest, France.
  • Éon B; Medical Intensive Care, Les Oudairies Hospital, La Roche Sur Yon, France.
  • Thirion M; Medical Intensive Care, Hospital de la Source, Orléans, France.
  • Rigaud JP; Medical Intensive Care, Assistance Publique Hôpitaux de Paris, Saint Louis University Hospital, Paris, France.
  • Philippon-Jouve B; Medical Intensive Care, Saint André University Hospital, Bordeaux, France.
  • Argaud L; Intensive Care, Angoulême Hospital, Angoulême, France.
  • Chouquer R; Anaesthesia and Intensive Care, Sainte Musse Hospital, Toulon, France.
  • Papazian L; Anaesthesia and Intensive Care, La Timone University Hospital, Marseille, France.
  • Dedrie C; Medical Intensive Care, Victor Dupouy Hospital, Argenteuil, France.
  • Georges H; Medical Intensive Care, Dieppe Hospital, Dieppe, France.
  • Lebas E; Intensive Care, Roanne Hospital, Roanne, France.
  • Rolin N; Medical Intensive Care, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France.
  • Bollaert PE; Lyon Est University, Lyon, France.
  • Lecuyer L; Intensive Care, Annecy Hospital, Annecy, France.
  • Viquesnel G; Medical Intensive Care, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
  • Leone M; Aix-Marseille University, Marseille, France.
  • Chalumeau-Lemoine L; Intensive Care, Roubaix Hospital, Roubaix, France.
  • Garrouste-Orgeas M; Intensive Care, Chatilliez Hospital, Tourcoing, France.
  • Azoulay E; Intensive Care, Bretagne Atlantique Hospital, Vannes, France.
  • Kentish-Barnes N; Medical Intensive Care, Groupe Hospitalier Sud Ile de France, Melun, France.
Crit Care ; 24(1): 521, 2020 08 25.
Article en En | MEDLINE | ID: mdl-32843097
BACKGROUND: As an increasing number of deaths occur in the intensive care unit (ICU), studies have sought to describe, understand, and improve end-of-life care in this setting. Most of these studies are centered on the patient's and/or the relatives' experience. Our study aimed to develop an instrument designed to assess the experience of physicians and nurses of patients who died in the ICU, using a mixed methodology and validated in a prospective multicenter study. METHODS: Physicians and nurses of patients who died in 41 ICUs completed the job strain and the CAESAR questionnaire within 24 h after the death. The psychometric validation was conducted using two datasets: a learning and a reliability cohort. RESULTS: Among the 475 patients included in the main cohort, 398 nurse and 417 physician scores were analyzed. The global score was high for both nurses [62/75 (59; 66)] and physicians [64/75 (61; 68)]. Factors associated with higher CAESAR-Nurse scores were absence of conflict with physicians, pain control handled with physicians, death disclosed to the family at the bedside, and invasive care not performed. As assessed by the job strain instrument, low decision control was associated with lower CAESAR score (61 (58; 65) versus 63 (60; 67), p = 0.002). Factors associated with higher CAESAR-Physician scores were room dedicated to family information, information delivered together by nurse and physician, families systematically informed of the EOL decision, involvement of the nurse during implementation of the EOL decision, and open visitation. They were also higher when a decision to withdraw or withhold treatment was made, no cardiopulmonary resuscitation was performed, and the death was disclosed to the family at the bedside. CONCLUSION: We described and validated a new instrument for assessing the experience of physicians and nurses involved in EOL in the ICU. This study shows important areas for improving practices.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Médicos / Psicometría / Actitud Frente a la Muerte / Acontecimientos que Cambian la Vida / Enfermeras y Enfermeros Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Año: 2020 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Médicos / Psicometría / Actitud Frente a la Muerte / Acontecimientos que Cambian la Vida / Enfermeras y Enfermeros Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Año: 2020 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido