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This survey is performed to examine if during the Covid's crisis, the practitionner's have respected the modalities of the law about the end of life, in particular concerning limitations and stop of therapeutics
In the current legislativ context notably the Clayes Leonetti law, a very large majority of ICU (Intensive Care Unit) patients die with the establishement of a procedure for the limitation and cessation of therapeutics (LAT). During a viral pandemic, medical resources can be saturated, limiting reflexive abilities in favour of binary decisions. This sorting of patients leads to LAT that could be performed without the elementary modalities stated by the law. Thus, arbitrary medical decisions made alone could expose patients to unjustified " loss of luck ". Increasing the resources mobilized during a pandemic must not make us forget the quality of care provided for the benefit of quantity. In therefore seems legitimate to keep the LAT modalities to ensure our ethical principles. No work in the literature based on actual facts explores the impact of a pandemic on compliance with and maintenance of ethical principles and the legisltaive framework, in particular as regards the procedures of the application of LAT.
The purpose of this study is to assess whether the terms of the LAT are being complied during a pandemic for patients with or without Covid.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patient 2019 | Patients hospitalized in selected centers during march and june 2019 |
| |
| Patient 2020 | Patients hospitalized in selected centers during march and june 2020 (during COVID-19 pandemia) |
| |
| Patient 2021 | Patients hospitalized in selected centers during march and june 2021 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| decisions of limitations and stop processing | Behavioral | Compliance of the modalities of decisions of limitations and stop processing |
|
| Measure | Description | Time Frame |
|---|---|---|
| decisions of limitations and therapeutic stops | The conformity of the modalities of the decisions of limitations and therapeutic stops will be evaluated by a composite criterion defined by the simultaneous presence of the 3 main modalities imposed by the Clayes-Leonetti law to achieve a limitation that are : An outside consultant's opinion ( required if no advance directives), the caregiver collegial discussion or adherence to patient advance directives, notification of decision in the medical record | at the end of patient's hospitalization, an average of one month |
| Measure | Description | Time Frame |
|---|---|---|
| Characteristics of the notification of LAT procedure | notification of the decision, the conclusions of the discussions, the opinion of the consultant and the arguments given to justify the LAT | at the end of patient's hospitalization, an average of one month |
| Characteristics of the LAT procedure (persons who participated to the collegial discussion) |
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Inclusion Criteria:
Exclusion Criteria:
None
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Patient hospitalized in disease infectious Unit, or Patient hospitalized in intensive reanimation Unit, or Patient hopsitalized in Internal medicine Unit.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lise LACLAUTRE | Contact | +33473754963 | promo_interne_drci@chu-clermontferrand.fr |
| Name | Affiliation | Role |
|---|---|---|
| Virginie Guastella | University Hospital, Clermont-Ferrand | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de Clermont-Ferrand | Recruiting | Clermont-Ferrand | 63000 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37536752 | Derived | Guastella V, Lambert C, Lafforgue A, Metretin P, Verstreate A, Watelet S, Perceau-Chambard E, Lautrette A. Withholding or withdrawing life-sustaining treatments in the COVID-19 pandemic: adherence to legal standards. BMJ Support Palliat Care. 2023 Aug 3:spcare-2023-004504. doi: 10.1136/spcare-2023-004504. Online ahead of print. |
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number and status of caregivers who participated to the collegial discussion |
| at the end of patient's hospitalization, an average of one month |
| Characteristics of consultant's reasoned opinion for the LAT procedure | formal elements of the consultant's reasoned opinion ( legal term) in the file | at the end of patient's hospitalization, an average of one month |
| Characteristics of the LAT procedure | formal elements of advance directives | at the end of patient's hospitalization, an average of one month |
| Characteristics of units | number of beds, number of caregivers (medical, paramedical, internal external), number of admissions during periods of study | day 0 |
| Age of physicians | measured in year | Day 0 |
| gendrer of physicians | male or female | Day 0 |
| Exparience of physicians | Measured in year of experience | Day 0 |
| Characteristics of physicians | professional status | Day 0 |
| Age of patients | measured in year | day 0 |
| patient's history | comorbidities | day 0 |
| COVID-19 patient's status | COVID19 infection (yes or no) | day 0 |
| Characteristics of hospitalization's patients | hospitalization reason | day 0 |
| Characteristics of affected organ | organ failure | day 0 |
| Characteristics of patients | severity score | day 0 |
| final patient status | fate | day 0 |
| patient's environnement | family presence or relatives | day 0 |
| Hospices Civiles de Lyon | Not yet recruiting | Lyon | 69000 | France |
|
| CH de Vichy | Not yet recruiting | Vichy | 03000 | France |
| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D014777 | Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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