Assessment of Factors Involved in the Decision-making for ICU Patients' Care

Assessment of Factors Involved in the Decision-making for ICU Patients' Care

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.

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).

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:

• Exclusion criteria for physician :
• Decline to participate