[The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end-of-life: improvement of the withholding and withdrawing treatment decision-making process by an educational program. A monocenter prospective and retrospective pilot study]. / Loi n° 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie : amélioration du processus de décision de limitation et d'arrêt des traitements au moyen d'un programme pédagogique. Étude monocentrique prospective et rétrospective pilote.

OBJECTIVE: To assess the impact of an educational program on the quality of the end-of-life decision (EOLD). METHODS: Prospective study for 3 months in a surgical Intensive Care Unit (ICU) involving: staff training conferences and guidelines for documenting level-of-care staff conference; audit before and at 3 months; analysis of records for deceased patients. The main outcome measures the proportion of treatment-limitation in dying ICU patients; and the secondary outcomes the decision-making process and nurses' satisfaction. RESULTS: Eighty-three patients were included; among them, 14 with EOLD. Pre-death palliative strategy increased from 51 % to 85 % with a persisting improvement of practices after 2 years. All steps of EOLD decision-making processes were traced in all such cases, 85 % being based on the proposed guidelines. Nursing team's satisfaction rate almost doubled to 70 %. DISCUSSION: The study demonstrate staff members' capacity to quickly improve their procedures for palliative care when provided with appropriate tools to think about the process and come to a decision. Our data suggest the potential benefice to extend this program to the other specialties involved in the end-of-life process.

Evolution of requests to hasten death among patients managed by palliative care teams in France: a multicentre cross-sectional survey (DemandE).

BACKGROUND: Strongly marked ideological positions on the impact of palliative care and limited hard data plague the debate on physician-assisted death. METHODS: A national cross-sectional study on the requests to hasten death (RHD) was conducted among 789 French palliative care organisations. Data were collected for all patients with RHD encountered during year 2010. Data on patients' characteristics, medical, psychological and social context, symptoms, nature of palliative management, patient's evolution and palliative care team's interpretation of the request were obtained. FINDINGS: A majority of centres responded and 342 teams provided descriptions of 783 RHD, 476 by a patient, 258 by relatives or close friends and 49 by the nursing staff. Cancer was the most frequent pathology (72%) and 68% of the patients had entered terminal stage. Patients rarely appeared with uncontrolled pain (3.7%), but had difficulties with feeding (65%), moving (54%), excretion (49%), or were cachectic (39%); 31% were considered to be anxio-depressive; 79% did not give physical reasons for their request; 37% of RHD were maintained and 24% fluctuated despite provision of regular follow-up by a palliative care team to 83% of all cases; 68% of patients died within a month; the interpretation of RHD by the staff was a wish for relief (69%), patient's inextricable situation (44%), actual desire not to continue living (36%) or to be helped to die (30%). INTERPRETATION: The large number of described cases provides, for the first time, comprehensive hard data on the evolution of RHDs in a country that has not legalised euthanasia. Whatever the way RHD are expressed, they are frequently maintained despite adequate palliative care with suitable control of pain and psychological support by specialists.