Admission criteria and management of critical care patients in a pandemic context: position of the Ethics Commission of the French Intensive Care Society, update of April 2021.

Intensive care unit professionals have experience in critical care and its proportionality, collegial decision-making, withholding or withdrawal of treatment deemed futile, and communication with patients' relatives. These elements rely on ethical values from which we must not deviate in a pandemic situation. The recommendations made by the Ethics Commission of the French Intensive Care Society reflect an approach of responsibility and solidarity towards our citizens regarding the potential impact of a pandemic on critical care resources in France, with the fundamental requirement of respect for human dignity and equal access to health care for all

Arrêt des traitements et idéologies thérapeutiques du cancer

Most cancer deaths in France occur in hospitals. Through in-depth interviews with 18 cancer physicians, we analyse their conceptions of ending cancer treatment and end of life care. All physicians point to specific difficulties with decision-making and team work. Two types of discourse appear granting different values to cancer treatment and end of life care. These two “therapeutic ideologies”, arising when cancer treatment is no longer useful, reveal different conceptions, no doubt crucial to medical practices and attitudes, about cancer trajectory and the role of physicians

Arrêt des traitements et idéologies thérapeutiques du cancer

Most cancer deaths in France occur in hospitals. Through in-depth interviews with 18 cancer physicians, we analyse their conceptions of ending cancer treatment and end of life care. All physicians point to specific difficulties with decision-making and team work. Two types of discourse appear granting different values to cancer treatment and end of life care. These two “therapeutic ideologies”, arising when cancer treatment is no longer useful, reveal different conceptions, no doubt crucial to medical practices and attitudes, about cancer trajectory and the role of physicians

Incertitude médicale, prise de décision et accompagnement en fin de vie

Ce numéro thématique sur l’incertitude médicale, la prise de décision et l’accompagnement en fin de vie relève quelques-uns des enjeux que comportent les décisions complexes et plurielles autour de la mort. La technologie et la biotechnologie réduisant les morts spontanées en milieu hospitalier, les professionnels du soin, les personnes malades et leurs proches doivent désormais composer avec des situations jadis exceptionnelles. Les articles réunis dans ce numéro s’appuient sur des corpus diversifiés, recueillis dans différents contextes nationaux (France, Italie, Suisse, Québec), ancrés dans un éventail de perspectives (les maladies génétiques, le cancer, la néonatalogie ou les soins intensifs), dans différents lieux (l’hôpital, les maisons et les unités de soins palliatifs ou encore le domicile) et à différents moments de la fin de vie (la palliation, la phase terminale, la sédation). In this special issue about medical uncertainty, decision-making and end-of-life accompaniment, the authors identify some of the various stakes of complex and plural decisions related to death. Technology and biotechnology reduce spontaneous deaths in hospitals. Thus, healthcare professionals, sick individuals and their relatives must now deal with situations once exceptional. The articles presented in this issue draw on corpuses of data that were collected in several national contexts (France, Italy, Switzerland, and Quebec) and diverse locations (hospital, palliative care unit, home). They broach end of life from manifold perspectives (genetic disorders, cancer, neonatal care, intensive care) and at various moments of it (palliation, terminal moments, and sedation)

“It Was the Only Thing I Could Hold Onto, But…”: Receiving a Letter of Condolence After Loss of a Loved One in the ICU

International audienceFamily members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members' experience of receiving a letter of condolence

Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial

International audiencePURPOSE: Family members of patients who die in the intensive care unit (ICU) may experience symptoms of stress, anxiety, depression, posttraumatic stress disorder (PTSD), and/or prolonged grief. We evaluated whether grief symptoms were alleviated if the physician and the nurse in charge at the time of death sent the closest relative a handwritten condolence letter.METHODS: Multicenter randomized trial conducted among 242 relatives of patients who died at 22 ICUs in France between December 2014 and October 2015. Relatives were randomly assigned to receiving (n = 123) or not receiving (n = 119) a condolence letter. The primary endpoint was the Hospital Anxiety and Depression Score (HADS) at 1 month. Secondary endpoints included HADS, complicated grief (ICG), and PTSD-related symptoms (IES-R) at 6 months. Observers were blinded to group allocation.RESULTS: At 1 month, 208 (85.9%) relatives completed the HADS; median score was 16 [IQR, 10-22] with and 14 [8-21.5] without the letter (P = 0.36). Although scores were higher in the intervention group, there were no significant differences regarding the HADS-depression subscale (8 [4-12] vs. 6 [2-12], mean difference 1.1 [-0.5 to 2.6]; P = 0.09) and prevalence of depression symptoms (56.0 vs. 42.4%, RR 0.76 [0.57-1.00]; P = 0.05). At 6 months, 190 (78.5%) relatives were interviewed. The intervention significantly increased the HADS (13 [7-19] vs. 10 [4-17.5], P = 0.04), HADS-depression subscale (6 [2-10] vs. 3 [1-9], P = 0.02), prevalence of depression symptoms (36.6 vs. 24.7%, P = 0.05) and PTSD-related symptoms (52.4 vs. 37.1%, P = 0.03).CONCLUSIONS: In relatives of patients who died in the ICU, a condolence letter failed to alleviate grief symptoms and may have worsened depression and PTSD-related symptoms. Trial registration Clinicaltrials.gov Identifier: NCT02325297

Complicated grief after death of a relative in the intensive care unit

International audienc