Written Document to Assist Family During Decision of Withholding and Withdrawing Life-sustaining Therapies in the Intensive Care Unit (LATA)

Written Document to Assist Family During Decision of Withholding and Withdrawing Life-sustaining Therapies in the Intensive Care Unit

Impact of a Written Document on Post Traumatic Stress Disorder (PTSD) Diagnosed in Family Members After Withholding and Withdrawing Life-sustaining Therapies in the Intensive Care Unit

Relatives of patients in situation of withholding and withdrawing life-sustaining therapies often show post traumatic stress disorder (PTSD) (60%)[1]. This number is even greater when family members are active in this decision (81%) or when communication is not optimal between medical team and family members. There are several ways to assist families of patients in intensive care units [2], amongst them the use of a written document to explain the environment, therapies and possible outcomes. Here the investigators want to test the impact of a written document in the context of end-of-life conference in intensive care units. Specifically, this research addresses wether such written support could decrease 3-months post-traumatic stress disorder, anxiety and depression exhibited by the closest family member or the patient representative.

Accompanying relatives with a written document when discussing withholding and withdrawing life-sustaining therapies . All other procedures are standard.

Discussing withholding and withdrawing life-sustaining therapies following standard procedure without written document

Depression is assessed with Hospital Anxiety and Depression scale (HADS) on the family representative

Length of the processus from decision to withhold and withdraw life-sustaining therapies to intensive care unit (ICU) discharge

Rate of decision to withhold and withdraw life-sustaining therapies in different intensive care units from the hospital

The study will enroll patient representant (family member or close friends designed by the family or pre-admission legal representant). Inclusion Criteria: Medical team anticipates a decision to withhold and withdraw life-sustaining therapies to intensive care unit (ICU) discharge verbal consent to participate Able to communicate in French Exclusion Criteria: representant of a patient < 18 years old representant of a patient whose stay in ICU lasted less than 48 hours representant of a patient without social security

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Schmidt M, Azoulay E. Having a loved one in the ICU: the forgotten family. Curr Opin Crit Care. 2012 Oct;18(5):540-7. doi: 10.1097/MCC.0b013e328357f141.

Robin S, Labarriere C, Sechaud G, Dessertaine G, Bosson JL, Payen JF. Information Pamphlet Given to Relatives During the End-of-Life Decision in the ICU: An Assessor-Blinded, Randomized Controlled Trial. Chest. 2021 Jun;159(6):2301-2308. doi: 10.1016/j.chest.2021.01.072. Epub 2021 Feb 5.