Publications et travaux de recherche
2023
Rigaud, Jean-Philippe; Ecarnot, Fiona; Quenot, Jean-Pierre
Patient Information and Consent for Care in the Intensive Care Unit Article de journal
Dans: Healthcare (Basel), vol. 11, no. 5, p. 707, 2023.
Résumé | Liens | BibTeX | Étiquettes: Droit des patients, Information
@article{Rigaud2023,
title = {Patient Information and Consent for Care in the Intensive Care Unit},
author = {Jean-Philippe Rigaud and Fiona Ecarnot and Jean-Pierre Quenot},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10001104/},
doi = {10.3390/healthcare11050707},
year = {2023},
date = {2023-02-27},
journal = {Healthcare (Basel)},
volume = {11},
number = {5},
pages = {707},
abstract = {In this paper, we review the ethical issues involved in providing information to, and obtaining consent (for treatment and/or research) from patients in the intensive care unit. We first review the ethical obligations of the physician in treating patients, who are by definition, vulnerable, and often unable to assert their autonomy during situations of critical illness. Providing clear and transparent information to the patient about treatment options or research opportunities is an ethical and, in some cases, legal obligation for the physicians, but may be rendered difficult, not to say impossible in the intensive care unit by the patient’s health state. In this context, we review the specificities of intensive care with respect to information and consent. We discuss who the right contact person is in the ICU setting, with possible choices including a surrogate decision maker, or a member of the family, in the absence of an officially designated surrogate. We further review the specific considerations relating to the family of critically ill patients, and the amount and type of information that may be given to them without breaching the tenets of medical confidentiality. Finally, we discuss the specific cases of consent to research, and patients who refuse care.},
keywords = {Droit des patients, Information},
pubstate = {published},
tppubtype = {article}
}
In this paper, we review the ethical issues involved in providing information to, and obtaining consent (for treatment and/or research) from patients in the intensive care unit. We first review the ethical obligations of the physician in treating patients, who are by definition, vulnerable, and often unable to assert their autonomy during situations of critical illness. Providing clear and transparent information to the patient about treatment options or research opportunities is an ethical and, in some cases, legal obligation for the physicians, but may be rendered difficult, not to say impossible in the intensive care unit by the patient’s health state. In this context, we review the specificities of intensive care with respect to information and consent. We discuss who the right contact person is in the ICU setting, with possible choices including a surrogate decision maker, or a member of the family, in the absence of an officially designated surrogate. We further review the specific considerations relating to the family of critically ill patients, and the amount and type of information that may be given to them without breaching the tenets of medical confidentiality. Finally, we discuss the specific cases of consent to research, and patients who refuse care.
2022
Moutel, Grégoire; Charvin, Maud; Suzat, Bertille; Gouriot, Mylène; Grandazzi, Guillaume
Directives anticipées et fin de vie : un outil à proposer et valoriser sans pour autant l’imposer Article de journal
Dans: Hépato-Gastro et Oncologie Digestive, vol. 29, no. 3, p. 289-94, 2022.
Résumé | Liens | BibTeX | Étiquettes: Fin de vie, Information
@article{Moutel2022cd,
title = {Directives anticipées et fin de vie : un outil à proposer et valoriser sans pour autant l’imposer},
author = {Grégoire Moutel and Maud Charvin and Bertille Suzat and Mylène Gouriot and Guillaume Grandazzi},
doi = {http://doi.org/10.1684/hpg.2022.2338},
year = {2022},
date = {2022-09-05},
urldate = {2022-09-05},
journal = {Hépato-Gastro et Oncologie Digestive},
volume = {29},
number = {3},
pages = {289-94},
abstract = {Les directives anticipées : un outil qui s’inscrit dans une évolution de la relation soignant-soigné et des droits des patients Dans une conception hippocratique, la relation médecin – patient découle directement de la morale aristotélicienne en se fondant sur le primum non nocere1. Historiquement, l’action médicale ayant pour finalité de faire du bien, en s’abstenant de nuire, elle se référait au principe [...]},
keywords = {Fin de vie, Information},
pubstate = {published},
tppubtype = {article}
}
Les directives anticipées : un outil qui s’inscrit dans une évolution de la relation soignant-soigné et des droits des patients Dans une conception hippocratique, la relation médecin – patient découle directement de la morale aristotélicienne en se fondant sur le primum non nocere1. Historiquement, l’action médicale ayant pour finalité de faire du bien, en s’abstenant de nuire, elle se référait au principe [...]
Gouriot, Mylène; Charvin, Maud; Suzat, Bertille; Moutel, Grégoire; Grandazzi, Guillaume
COVID et privation du droit de visites en établissement sanitaire et médico-social : maintenir la relation et penser l'usage des outils numériques Article de journal
Dans: Journal International de Bioéthique, vol. 33, no. 2, p. 63-85, 2022.
Résumé | Liens | BibTeX | Étiquettes: Information
@article{Moutel2022ce,
title = {COVID et privation du droit de visites en établissement sanitaire et médico-social : maintenir la relation et penser l'usage des outils numériques},
author = {Mylène Gouriot and Maud Charvin and Bertille Suzat and Grégoire Moutel and Guillaume Grandazzi},
url = {https://journaleska.com/index.php/jidb/article/view/7458},
year = {2022},
date = {2022-09-05},
urldate = {2022-09-05},
journal = {Journal International de Bioéthique},
volume = {33},
number = {2},
pages = {63-85},
abstract = {Le droit de visites des familles et des proches a été remis en cause lors de l’épidémie de COVID. Dans les établissements sanitaires et médico-sociaux, la limitation de ces visites a et continue d’avoir des conséquences sur les personnes prises en charge, leur entourage et les professionnels. Cet article présente les analyses de la Cellule de Soutien Ethique Normande mise en place au début de la crise COVID, en réponse aux saisines du terrain sur ce sujet des interdictions de visites. Cette crise a permis de rappeler l’importance du contact physique avec les patients et les résidents pour maintenir les liens sociaux. Elle a également attiré l’attention collective sur la nécessité de mise en place d’outils numériques pour pallier l’éloignement géographique, le manque de temps, et plus largement l’évolution de la société. Indépendamment de la crise COVID qui a révélé cette question, il convient de l’intégrer à l’avenir pour améliorer l’accompagnement des personnes hébergées. Le déploiement d’outils numériques soulève de nombreux questionnements éthiques et doit être envisagé sans pour autant négliger les contacts physiques.},
keywords = {Information},
pubstate = {published},
tppubtype = {article}
}
Le droit de visites des familles et des proches a été remis en cause lors de l’épidémie de COVID. Dans les établissements sanitaires et médico-sociaux, la limitation de ces visites a et continue d’avoir des conséquences sur les personnes prises en charge, leur entourage et les professionnels. Cet article présente les analyses de la Cellule de Soutien Ethique Normande mise en place au début de la crise COVID, en réponse aux saisines du terrain sur ce sujet des interdictions de visites. Cette crise a permis de rappeler l’importance du contact physique avec les patients et les résidents pour maintenir les liens sociaux. Elle a également attiré l’attention collective sur la nécessité de mise en place d’outils numériques pour pallier l’éloignement géographique, le manque de temps, et plus largement l’évolution de la société. Indépendamment de la crise COVID qui a révélé cette question, il convient de l’intégrer à l’avenir pour améliorer l’accompagnement des personnes hébergées. Le déploiement d’outils numériques soulève de nombreux questionnements éthiques et doit être envisagé sans pour autant négliger les contacts physiques.
2020
Charvin, Maud; Launoy, Guy; Berchi, Célia
The effect of information on prostate cancer screening decision process: a discrete choice experiment Article de journal
Dans: BMC Health Services Research, 2020.
Résumé | Liens | BibTeX | Étiquettes: Dépistage des cancers, Information
@article{Charvin2020,
title = {The effect of information on prostate cancer screening decision process: a discrete choice experiment},
author = {Maud Charvin and Guy Launoy and Célia Berchi },
doi = {https://doi.org/10.1186/s12913-020-05327-x},
year = {2020},
date = {2020-05-26},
urldate = {2020-05-26},
journal = {BMC Health Services Research},
abstract = {Background
Prostate cancer screening is controversial because of uncertainty about its benefits and risks. The aim of this survey was to reveal preferences of men concerning prostate cancer screening and to test the effect of an informative video on these preferences.
Methods
A stated preferences questionnaire was sent by e-mail to men aged 50–75 with no history of prostate cancer. Half of them were randomly assigned to view an informative video. A discrete choice model was established to reveal men’s preferences for six prostate cancer screening characteristics: mortality by prostate cancer, number of false positive and false negative results, number of overdiagnosis, out-of-pocket costs and recommended frequency.
Results
A population-based sample composed by 1024 men filled in the entire questionnaire. Each attribute gave the expected sign except for overdiagnosis. The video seemed to increase the intention to abstain from prostate cancer screening.
Conclusions
The participants attached greater importance to a decrease in the number of false negatives and a reduction in prostate cancer mortality than to other risks such as the number of false positives and overdiagnosis. Further research is needed to help men make an informed choice regarding screening.},
keywords = {Dépistage des cancers, Information},
pubstate = {published},
tppubtype = {article}
}
Background
Prostate cancer screening is controversial because of uncertainty about its benefits and risks. The aim of this survey was to reveal preferences of men concerning prostate cancer screening and to test the effect of an informative video on these preferences.
Methods
A stated preferences questionnaire was sent by e-mail to men aged 50–75 with no history of prostate cancer. Half of them were randomly assigned to view an informative video. A discrete choice model was established to reveal men’s preferences for six prostate cancer screening characteristics: mortality by prostate cancer, number of false positive and false negative results, number of overdiagnosis, out-of-pocket costs and recommended frequency.
Results
A population-based sample composed by 1024 men filled in the entire questionnaire. Each attribute gave the expected sign except for overdiagnosis. The video seemed to increase the intention to abstain from prostate cancer screening.
Conclusions
The participants attached greater importance to a decrease in the number of false negatives and a reduction in prostate cancer mortality than to other risks such as the number of false positives and overdiagnosis. Further research is needed to help men make an informed choice regarding screening.
Prostate cancer screening is controversial because of uncertainty about its benefits and risks. The aim of this survey was to reveal preferences of men concerning prostate cancer screening and to test the effect of an informative video on these preferences.
Methods
A stated preferences questionnaire was sent by e-mail to men aged 50–75 with no history of prostate cancer. Half of them were randomly assigned to view an informative video. A discrete choice model was established to reveal men’s preferences for six prostate cancer screening characteristics: mortality by prostate cancer, number of false positive and false negative results, number of overdiagnosis, out-of-pocket costs and recommended frequency.
Results
A population-based sample composed by 1024 men filled in the entire questionnaire. Each attribute gave the expected sign except for overdiagnosis. The video seemed to increase the intention to abstain from prostate cancer screening.
Conclusions
The participants attached greater importance to a decrease in the number of false negatives and a reduction in prostate cancer mortality than to other risks such as the number of false positives and overdiagnosis. Further research is needed to help men make an informed choice regarding screening.
Benoit, Alexandra; Grynberg, Michael; Morello, Rémy; Sermondade, Nathalie; Grandazzi, Guillaume; Moutel, Grégoire
Does a web-based decision aid improve informed choice for fertility preservation in women with breast cancer (DECISIF)? Study protocol for a randomized controlled trial Article de journal
Dans: BMJ Open, 2020.
Résumé | Liens | BibTeX | Étiquettes: Décision partagée, Information
@article{Benoit2020,
title = {Does a web-based decision aid improve informed choice for fertility preservation in women with breast cancer (DECISIF)? Study protocol for a randomized controlled trial },
author = {Alexandra Benoit and Michael Grynberg and Rémy Morello and Nathalie Sermondade and Guillaume Grandazzi and Grégoire Moutel},
doi = {10.1136/bmjopen-2019-031739},
year = {2020},
date = {2020-02-10},
urldate = {2020-02-10},
journal = {BMJ Open},
abstract = {Introduction: Chemotherapy may cause infertility in young survivors of breast cancer. Various fertility preservation techniques increase the likelihood of survivors becoming genetic mothers. Disclosure of cancer diagnosis may impact decision making about fertility preservation. This protocol will develop and test the effectiveness of a web-based decision aid for helping women with breast cancer to make well-informed choices about fertility preservation.
Methods and analysis: This study will be conducted in three phases using mixed methods. In phase I, the aim is to develop a web-based patient decision aid (PDA) in French with a steering committee and using a focus group of five women already treated for breast cancer. In phase II, the face validity of the decision aid will be assessed using questionnaires. In phase III, the PDA will be assessed by a two-arm randomised controlled trial. This will involve a quantitative evaluation of the PDA in clinical practice comparing the quality of the decision-making process between usual care and the PDA. The primary outcome will be informed choice and its components. The secondary outcomes will be decisional conflict and anxiety. Data will be collected during and after an oncofertility consultation. Phase III is underway. Since September 2018, 52 participants have been enrolled in the study and have completed the survey. We expect to have results by February 2020 for a total of 186 patients.},
keywords = {Décision partagée, Information},
pubstate = {published},
tppubtype = {article}
}
Introduction: Chemotherapy may cause infertility in young survivors of breast cancer. Various fertility preservation techniques increase the likelihood of survivors becoming genetic mothers. Disclosure of cancer diagnosis may impact decision making about fertility preservation. This protocol will develop and test the effectiveness of a web-based decision aid for helping women with breast cancer to make well-informed choices about fertility preservation.
Methods and analysis: This study will be conducted in three phases using mixed methods. In phase I, the aim is to develop a web-based patient decision aid (PDA) in French with a steering committee and using a focus group of five women already treated for breast cancer. In phase II, the face validity of the decision aid will be assessed using questionnaires. In phase III, the PDA will be assessed by a two-arm randomised controlled trial. This will involve a quantitative evaluation of the PDA in clinical practice comparing the quality of the decision-making process between usual care and the PDA. The primary outcome will be informed choice and its components. The secondary outcomes will be decisional conflict and anxiety. Data will be collected during and after an oncofertility consultation. Phase III is underway. Since September 2018, 52 participants have been enrolled in the study and have completed the survey. We expect to have results by February 2020 for a total of 186 patients.
Methods and analysis: This study will be conducted in three phases using mixed methods. In phase I, the aim is to develop a web-based patient decision aid (PDA) in French with a steering committee and using a focus group of five women already treated for breast cancer. In phase II, the face validity of the decision aid will be assessed using questionnaires. In phase III, the PDA will be assessed by a two-arm randomised controlled trial. This will involve a quantitative evaluation of the PDA in clinical practice comparing the quality of the decision-making process between usual care and the PDA. The primary outcome will be informed choice and its components. The secondary outcomes will be decisional conflict and anxiety. Data will be collected during and after an oncofertility consultation. Phase III is underway. Since September 2018, 52 participants have been enrolled in the study and have completed the survey. We expect to have results by February 2020 for a total of 186 patients.
2016
Rigaud, Jean-Philippe; Moutel, Grégoire; Quesnel, Corinne; Eraldi, Jean-Pierre; Bougerol, François; Pavon, Arnaud; Quenot, Jean-Pierre
How patient families are provided with information during intensive care: A survey of practices Article de journal
Dans: Anaesthesia Critical Care & Pain Medicine, vol. 35, no. 3, p. 185-189, 2016.
Résumé | Liens | BibTeX | Étiquettes: Information
@article{Rigaud2016,
title = {How patient families are provided with information during intensive care: A survey of practices},
author = {Jean-Philippe Rigaud and Grégoire Moutel and Corinne Quesnel and Jean-Pierre Eraldi and François Bougerol and Arnaud Pavon and Jean-Pierre Quenot},
doi = {https://doi.org/10.1016/j.accpm.2016.03.002},
year = {2016},
date = {2016-06-01},
urldate = {2016-06-01},
journal = {Anaesthesia Critical Care & Pain Medicine},
volume = {35},
number = {3},
pages = {185-189},
abstract = {Background
Many critically ill patients are incapable of receiving information or expressing their own opinion on treatment decisions due to the severity of their disease, or because they are under sedation. French legislation requires that when a physician proposes further tests or treatment for a patient, this proposal should be accompanied by clear and honest information that is appropriate in view of the circumstances and the patient's state of health, and the physician must obtain the patient's consent before proceeding. However, this is often impossible in critical care. We evaluated whether provisions for surrogates are adequate in meeting information needs of patients and families in critical care.
Methods
Survey of intensive care physicians by electronic questionnaire in December 2010 and January 2011 to evaluate actual practices. The questionnaire comprised 6 domains covering various aspects relating to the information of patients’ relatives as regards diagnostic testing in critical care, when the patient was unable to be appropriately informed. We recorded responders’ socio-demographic data (age, how long in practice, where they practised).
Results
Among 1279 physicians contacted, 139 (10.8%) from 98 critical care departments (France, Belgium, Switzerland) responded. A total of 66.2% said they believed it is possible to perform diagnostic tests without informing the patient's relatives. Invasive or high-risk tests, time available to provide information, and quality of prior relations with the patient's family were factors likely to prompt the physician to inform the family, while potentially serious implications for the relatives, and degree of relation of the family member to the patient were reported to make the physician more reluctant to inform relatives. Less than 6% considered routine procedures to require provision of information to relatives.
Conclusion
Our results suggest that modalities for providing information to families and relatives, as defined by current French legislation, are not suitable to the context of critical care.},
keywords = {Information},
pubstate = {published},
tppubtype = {article}
}
Background
Many critically ill patients are incapable of receiving information or expressing their own opinion on treatment decisions due to the severity of their disease, or because they are under sedation. French legislation requires that when a physician proposes further tests or treatment for a patient, this proposal should be accompanied by clear and honest information that is appropriate in view of the circumstances and the patient's state of health, and the physician must obtain the patient's consent before proceeding. However, this is often impossible in critical care. We evaluated whether provisions for surrogates are adequate in meeting information needs of patients and families in critical care.
Methods
Survey of intensive care physicians by electronic questionnaire in December 2010 and January 2011 to evaluate actual practices. The questionnaire comprised 6 domains covering various aspects relating to the information of patients’ relatives as regards diagnostic testing in critical care, when the patient was unable to be appropriately informed. We recorded responders’ socio-demographic data (age, how long in practice, where they practised).
Results
Among 1279 physicians contacted, 139 (10.8%) from 98 critical care departments (France, Belgium, Switzerland) responded. A total of 66.2% said they believed it is possible to perform diagnostic tests without informing the patient's relatives. Invasive or high-risk tests, time available to provide information, and quality of prior relations with the patient's family were factors likely to prompt the physician to inform the family, while potentially serious implications for the relatives, and degree of relation of the family member to the patient were reported to make the physician more reluctant to inform relatives. Less than 6% considered routine procedures to require provision of information to relatives.
Conclusion
Our results suggest that modalities for providing information to families and relatives, as defined by current French legislation, are not suitable to the context of critical care.
Many critically ill patients are incapable of receiving information or expressing their own opinion on treatment decisions due to the severity of their disease, or because they are under sedation. French legislation requires that when a physician proposes further tests or treatment for a patient, this proposal should be accompanied by clear and honest information that is appropriate in view of the circumstances and the patient's state of health, and the physician must obtain the patient's consent before proceeding. However, this is often impossible in critical care. We evaluated whether provisions for surrogates are adequate in meeting information needs of patients and families in critical care.
Methods
Survey of intensive care physicians by electronic questionnaire in December 2010 and January 2011 to evaluate actual practices. The questionnaire comprised 6 domains covering various aspects relating to the information of patients’ relatives as regards diagnostic testing in critical care, when the patient was unable to be appropriately informed. We recorded responders’ socio-demographic data (age, how long in practice, where they practised).
Results
Among 1279 physicians contacted, 139 (10.8%) from 98 critical care departments (France, Belgium, Switzerland) responded. A total of 66.2% said they believed it is possible to perform diagnostic tests without informing the patient's relatives. Invasive or high-risk tests, time available to provide information, and quality of prior relations with the patient's family were factors likely to prompt the physician to inform the family, while potentially serious implications for the relatives, and degree of relation of the family member to the patient were reported to make the physician more reluctant to inform relatives. Less than 6% considered routine procedures to require provision of information to relatives.
Conclusion
Our results suggest that modalities for providing information to families and relatives, as defined by current French legislation, are not suitable to the context of critical care.
