Peretti-Watel Patrick, Bendiane Marc-Karim, Galinier Anne, Favre Roger, Ribiere Claude, Lapiana Jean-Marc, Obadia Yolande
INSERM, UMR379, Institut Paoli-Calmettes, Epidemiology and Social Sciences Unit, F-13000 Marseille, France.
J Crit Care. 2008 Sep;23(3):332-8. doi: 10.1016/j.jcrc.2007.11.007. Epub 2008 Apr 23.
In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses' attitudes toward terminally ill patients' autonomy.
We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses' religiosity, nurses' attitudes toward living wills, and patient sex.
Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent.
A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient's will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship.
在法国，一项近期的法律强调了患者权利，并禁止在临终关怀中进行不必要的治疗。随着临终家庭护理的增加，我们旨在评估法国社区护士对绝症患者自主权的态度。
我们使用了2005年对法国社区护士随机抽样（n = 602）进行的全国性电话调查数据。通过一个临床案例评估护士的态度，该案例描述了一名患有肌萎缩侧索硬化症（ALS）、急需机械通气的患者（随机定义为一名50岁男性或女性）。询问护士在进行插管/气管切开术前患者同意是否必要，分析考虑了各种协变量，包括护士的宗教信仰、护士对生前预嘱的态度以及患者性别。
总体而言，44%的护士认为呼吸衰竭的ALS患者应始终进行插管（女性患者为53%，男性患者为40%，P <.01），插管后，27%的人支持气管切开，而不将患者同意视为必要前提（男护士中为39%，女护士中为30%，P <.05）。与临终患者沟通不畅以及对生前预嘱的敌意也预示着在未经患者同意的情况下愿意进行机械通气和气管切开。
很大一部分法国社区护士可能有令人不安的倾向，即支持插管和气管切开，而对患者意愿关注不足。进一步的研究应调查潜在的因果因素（如工作量增加）以及护患关系中与性别相关的态度。
