Impact of advance directives on factors involved in the decision-making in ICU

Overview & Synopsis

Introduction: Physicians do not know how to follow the patients’ wishes when they are unable to express themselves. We assessed the impact of Advances Directives (AD) and how they have been written on the physician’s decisions. Methods: A multicentre, prospective, interventional, simulation study was carried out. Height patients were recruited and wrote AD after receiving clear and complete information by video and interview with one ICU physician. Two simulation scenarios including 10 questions about ICU admission and situations of withholding/withdrawing therapies using the patients’ characteristics were submitted to ICU physicians from 28 French ICU, in three rounds (R): simulation without knowledge of the patient’s AD (R1), with these AD (R2) and with these AD and the knowledge of how they were carried out (R3). Results: The preliminary results were performed on data of 82 physicians. The variability betweenphysicians themselves was high. Among the 80 questions of R1, there were 40, 23 and 17 questions with an agreement > 80%, 80-60% and 80%, and increased the number of questions with an agreement