Ethical Deliberation in the Intensive Care Unit, Impact of Formalized Multidisciplinary Team Meetings, a Pilot Study

Délibération éthique en réanimation, Impact de la Mise en Place de réunions éthiques formalisées, Une étude Pilote

Most patients who die in the intensive care unit do so after a withholding or withdrawing of life sustaining treatments (WWLST) decision. The implementation of formalized interdisciplinary team meetings for ethical deliberation in the ICU may improve nurses participation in WWLST decisions. The investigators decided to implement such team meetings in their ICU. At this occasion, the investigators will measure job satisfaction, job related frustration and ethical decision making climate climate.

Study Overview

• Status: Recruiting
• Conditions: Ethics, Narrative

Detailed Description

Most patients who die in the intensive care unit do so after a withholding or withdrawing of life sustaining treatments (WWLST) decision. Because those decisions are value-laden, guidelines as well as french regulations recommend that they should involve not only medical doctors but also nurses. Despite that, nurses' involvement remains incomplete. Poor collaboration between doctors and nurses on ethical decisions is associated with job dissatisfaction, burnout and desire to quit. The implementation of formalized interdisciplinary team meetings for ethical deliberation in the ICU may improve nurses participation in WWLST decisions.

For those reasons the investigators decided to implement such team meetings in their ICU. At this occasion, the investigators will measure job satisfaction, job related frustration and ethical decision making climate climate.

• Study Type: Observational
• Enrollment (Anticipated): 200

Contacts and Locations

• Study Contact: Name: Romain Miguel Montanes, MD; Phone Number: 0247474747; Email: r.miguelmontanes@chu-tours.fr
• Study Contact Backup: Name: Wiebe de JONG, MSc; Phone Number: +33(0)247474680; Email: w.dejong@chu-tours.fr

Study Locations

• France
  • Tours, France, 37000
    • Recruiting
    • Trauma and surgical intensive care unit, Tours University Hospital
    • Contact: Romain Miguel Montanes; Phone Number: 0247474747; Email: r.miguelmontanes@chu-tours.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

All patients admitted in the ICU

Description

Inclusion Criteria:

• All patients admitted in the ICU

Exclusion Criteria:

• Age below 18

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in nurses perception of ethical decision making climate in the ICU	Nurses answers to the questionnaire "Ethical Decision-Making Climate Questionnaire (7 factors evaluated, for each factor score ranges from 1 to 5, higher scores indicate a better climate)".	june 2023, january 2024

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in nurses psychological well being at work	Nurses answers to the Index of psychological well being at work (5 factors, for each factor score ranges from 1 to 5, higher scores indicate more well being).	2 evaluations: may 2023, january 2024
Change in nurses frustration of job's related psychological needs	Nurses answers to the Job related psychological needs frustration score (3 factors, for each factor score ranges from 1 to 5, higher score indicate more frustration)	2 evaluations: may 2023, january 2024
Change in nurses desire to leave	Nurses answers to a one question questionnaire: "I have thoughts about leaving my current position/job" (lickert scale, score range from 1 to 5, higher score indicate a higher desire to leave)	2 evaluations: may 2023, january 2024
Non beneficial care	Duration of mechanical ventilation in patients who ultimately die (number of days)	January 2024

Collaborators and Investigators

• Sponsor: University Hospital, Tours
• Investigators: Principal Investigator: ROMAIN MIGUEL MONTANES, MD, University Hospital of Tours; Principal Investigator: Servane Barrault, PhD, University of Tours

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2023
• Primary Completion (Anticipated): March 31, 2024
• Study Completion (Anticipated): July 31, 2024

Study Registration Dates

• First Submitted: January 11, 2023
• First Submitted That Met QC Criteria: January 31, 2023
• First Posted (Actual): February 10, 2023

Study Record Updates

• Last Update Posted (Actual): May 11, 2023
• Last Update Submitted That Met QC Criteria: May 10, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: End of life decisions in the ICU; Multidisciplinary team meetings; Ethical decision making climate; Nurses job satisfaction
• Other Study ID Numbers: DER

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No