Publications et travaux de recherche
2025
Charbonnier, Charlotte; Bellot, Anne; Moutel, Grégoire; Alexandre, Mélanie
Practical implementation of the collegial decision-making procedure in case of possible unreasonable obstinacy in Neonatology Article de journal
Dans: Archives de Pédiatrie, vol. 32, no. 5, p. 307-313, 2025.
Résumé | Liens | BibTeX | Étiquettes: Collégialité, Néonatalogie, Obstination déraisonnable
@article{Charbonnier2025,
title = {Practical implementation of the collegial decision-making procedure in case of possible unreasonable obstinacy in Neonatology},
author = {Charlotte Charbonnier and Anne Bellot and Grégoire Moutel and Mélanie Alexandre},
url = {https://www.sciencedirect.com/science/article/abs/pii/S0929693X25000740},
doi = {10.1016/j.arcped.2025.03.002},
year = {2025},
date = {2025-07-01},
urldate = {2025-07-01},
journal = {Archives de Pédiatrie},
volume = {32},
number = {5},
pages = {307-313},
abstract = {Introduction
The withholding or withdrawal of life-sustaining treatment has become the predominant cause of death in neonatal intensive care units. The advancements in perinatal medicine have led to a re-evaluation of the necessity and relevance of initiating and maintaining those treatments in patients whose conditions are not expected to improve. This decision must be made in accordance with the codified collegial decision-making process outlined in French law. In light of the shifts in end-of-life care, a review of professional practice is crucial.
Objective
The objective of this study was to analyze the practical implementation of the collegial decision-making process in the Neonatology Department of the Caen University Hospital. The analysis focused on three key areas: the logistical setup, the compliance with the legal framework, and the deliberation mechanisms for each collegial decision-making process. To assess the implementation of the limitation of life-sustaining treatment meetings, a variety of methods were employed, including participant observation, review of medical records, and the distribution of surveys to participants.
Results
In one year, 16 collegial decision-making processes were initiated, and 20 meetings were scheduled to discuss the restrictions on life-sustaining treatment. In 2 cases, the process was initiated by parents. The primary clinical condition that prompted the implementation of a collegial procedure was neurological. The presence of an external consultant was noted in 19 times. In 3 out of 20 times, parents weren't notified of their child's meeting prior to the date but all were informed of the meeting's conclusions. Data indicate a statistically significant correlation between professional category and perceived freedom to speak and legitimacy to do so, and the influence of the legal guardian's viewpoint on the participants' thinking.
Conclusion
The legal framework was generally respected, and the culture of service facilitated the incorporation of the collegial procedure into the habits of professionals.},
keywords = {Collégialité, Néonatalogie, Obstination déraisonnable},
pubstate = {published},
tppubtype = {article}
}
Introduction
The withholding or withdrawal of life-sustaining treatment has become the predominant cause of death in neonatal intensive care units. The advancements in perinatal medicine have led to a re-evaluation of the necessity and relevance of initiating and maintaining those treatments in patients whose conditions are not expected to improve. This decision must be made in accordance with the codified collegial decision-making process outlined in French law. In light of the shifts in end-of-life care, a review of professional practice is crucial.
Objective
The objective of this study was to analyze the practical implementation of the collegial decision-making process in the Neonatology Department of the Caen University Hospital. The analysis focused on three key areas: the logistical setup, the compliance with the legal framework, and the deliberation mechanisms for each collegial decision-making process. To assess the implementation of the limitation of life-sustaining treatment meetings, a variety of methods were employed, including participant observation, review of medical records, and the distribution of surveys to participants.
Results
In one year, 16 collegial decision-making processes were initiated, and 20 meetings were scheduled to discuss the restrictions on life-sustaining treatment. In 2 cases, the process was initiated by parents. The primary clinical condition that prompted the implementation of a collegial procedure was neurological. The presence of an external consultant was noted in 19 times. In 3 out of 20 times, parents weren't notified of their child's meeting prior to the date but all were informed of the meeting's conclusions. Data indicate a statistically significant correlation between professional category and perceived freedom to speak and legitimacy to do so, and the influence of the legal guardian's viewpoint on the participants' thinking.
Conclusion
The legal framework was generally respected, and the culture of service facilitated the incorporation of the collegial procedure into the habits of professionals.
The withholding or withdrawal of life-sustaining treatment has become the predominant cause of death in neonatal intensive care units. The advancements in perinatal medicine have led to a re-evaluation of the necessity and relevance of initiating and maintaining those treatments in patients whose conditions are not expected to improve. This decision must be made in accordance with the codified collegial decision-making process outlined in French law. In light of the shifts in end-of-life care, a review of professional practice is crucial.
Objective
The objective of this study was to analyze the practical implementation of the collegial decision-making process in the Neonatology Department of the Caen University Hospital. The analysis focused on three key areas: the logistical setup, the compliance with the legal framework, and the deliberation mechanisms for each collegial decision-making process. To assess the implementation of the limitation of life-sustaining treatment meetings, a variety of methods were employed, including participant observation, review of medical records, and the distribution of surveys to participants.
Results
In one year, 16 collegial decision-making processes were initiated, and 20 meetings were scheduled to discuss the restrictions on life-sustaining treatment. In 2 cases, the process was initiated by parents. The primary clinical condition that prompted the implementation of a collegial procedure was neurological. The presence of an external consultant was noted in 19 times. In 3 out of 20 times, parents weren't notified of their child's meeting prior to the date but all were informed of the meeting's conclusions. Data indicate a statistically significant correlation between professional category and perceived freedom to speak and legitimacy to do so, and the influence of the legal guardian's viewpoint on the participants' thinking.
Conclusion
The legal framework was generally respected, and the culture of service facilitated the incorporation of the collegial procedure into the habits of professionals.
2023
Quenot, Jean-Pierre; Jacquier, Marine; Fournel, Isabelle; Meunier-Beillard, Nicolas; Grangé, Clotilde; Ecarnot, Fiona; Labruyère, Marie; Rigaud, Jean-Philippe; RESC, Study Group
Non-beneficial admission to the intensive care unit: A nationwide survey of practices Article de journal
Dans: PLoS One, vol. 18, no. 2, p. e0279939, 2023.
Résumé | Liens | BibTeX | Étiquettes: Collégialité, Organisation du système de santé
@article{Quenot2023,
title = {Non-beneficial admission to the intensive care unit: A nationwide survey of practices},
author = {Jean-Pierre Quenot and Marine Jacquier and Isabelle Fournel and Nicolas Meunier-Beillard and Clotilde Grangé and Fiona Ecarnot and Marie Labruyère and Jean-Philippe Rigaud and Study Group RESC},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894425/},
doi = {10.1371/journal.pone.0279939},
year = {2023},
date = {2023-02-02},
urldate = {2023-02-02},
journal = {PLoS One},
volume = {18},
number = {2},
pages = {e0279939},
abstract = {Introduction
In a nationwide survey of practices, we sought to define the criteria, circumstances and consequences of non-beneficial admissions to the intensive care unit (ICU), with a view to proposing measures to avoid such situations.
Methods
ICU physicians from a French research in ethics network participated in an online survey. The first part recorded age, sex, and years’ experience of the participants. In the second part, there were 8 to 12 proposals on each of 4 main domains: (1) What criteria could be used to qualify an ICU stay as non-beneficial? (2) What circumstances result in the admission of a patient whose ICU stay may later be deemed non-beneficial? (3) What are the consequences of a non-beneficial stay in the ICU? (4) What measures could be implemented to avoid admissions that later come to be considered as non-beneficial? Responses were on a 5-point Likert scale ranging from “Strongly disagree” to “Strongly agree”.
Results
Among 164 physicians contacted, 154 (94%) responded. The majority cited several criteria used to qualify a stay as non-beneficial. Similarly, >80% cited several possible circumstances that could result in non-beneficial admissions, including lack of knowledge of the case and the patient’s history, and failure to anticipate acute deterioration. Possible consequences of non-beneficial stays included stress and anxiety for the patient/family, misunderstandings and conflict. Discussing the utility of possible ICU admission in the framework of the patient’s overall healthcare goals was hailed as a means to prevent non-beneficial admissions.
Conclusion
The results of this survey suggest that joint discussions should take place during the patient’s healthcare trajectory, before the acute need for ICU arises, with a view to limiting or avoiding ICU stays that may later come to be deemed “non-beneficial”.},
keywords = {Collégialité, Organisation du système de santé},
pubstate = {published},
tppubtype = {article}
}
Introduction
In a nationwide survey of practices, we sought to define the criteria, circumstances and consequences of non-beneficial admissions to the intensive care unit (ICU), with a view to proposing measures to avoid such situations.
Methods
ICU physicians from a French research in ethics network participated in an online survey. The first part recorded age, sex, and years’ experience of the participants. In the second part, there were 8 to 12 proposals on each of 4 main domains: (1) What criteria could be used to qualify an ICU stay as non-beneficial? (2) What circumstances result in the admission of a patient whose ICU stay may later be deemed non-beneficial? (3) What are the consequences of a non-beneficial stay in the ICU? (4) What measures could be implemented to avoid admissions that later come to be considered as non-beneficial? Responses were on a 5-point Likert scale ranging from “Strongly disagree” to “Strongly agree”.
Results
Among 164 physicians contacted, 154 (94%) responded. The majority cited several criteria used to qualify a stay as non-beneficial. Similarly, >80% cited several possible circumstances that could result in non-beneficial admissions, including lack of knowledge of the case and the patient’s history, and failure to anticipate acute deterioration. Possible consequences of non-beneficial stays included stress and anxiety for the patient/family, misunderstandings and conflict. Discussing the utility of possible ICU admission in the framework of the patient’s overall healthcare goals was hailed as a means to prevent non-beneficial admissions.
Conclusion
The results of this survey suggest that joint discussions should take place during the patient’s healthcare trajectory, before the acute need for ICU arises, with a view to limiting or avoiding ICU stays that may later come to be deemed “non-beneficial”.
In a nationwide survey of practices, we sought to define the criteria, circumstances and consequences of non-beneficial admissions to the intensive care unit (ICU), with a view to proposing measures to avoid such situations.
Methods
ICU physicians from a French research in ethics network participated in an online survey. The first part recorded age, sex, and years’ experience of the participants. In the second part, there were 8 to 12 proposals on each of 4 main domains: (1) What criteria could be used to qualify an ICU stay as non-beneficial? (2) What circumstances result in the admission of a patient whose ICU stay may later be deemed non-beneficial? (3) What are the consequences of a non-beneficial stay in the ICU? (4) What measures could be implemented to avoid admissions that later come to be considered as non-beneficial? Responses were on a 5-point Likert scale ranging from “Strongly disagree” to “Strongly agree”.
Results
Among 164 physicians contacted, 154 (94%) responded. The majority cited several criteria used to qualify a stay as non-beneficial. Similarly, >80% cited several possible circumstances that could result in non-beneficial admissions, including lack of knowledge of the case and the patient’s history, and failure to anticipate acute deterioration. Possible consequences of non-beneficial stays included stress and anxiety for the patient/family, misunderstandings and conflict. Discussing the utility of possible ICU admission in the framework of the patient’s overall healthcare goals was hailed as a means to prevent non-beneficial admissions.
Conclusion
The results of this survey suggest that joint discussions should take place during the patient’s healthcare trajectory, before the acute need for ICU arises, with a view to limiting or avoiding ICU stays that may later come to be deemed “non-beneficial”.
2022
Moutel, Grégoire; Goupille, Pauline; Suzat, Bertille; Rigaud, Jean-Philippe; Charvin, Maud; Grandazzi, Guillaume; Gouriot, Mylène; Gakuba, Clément; Gaberel, Thomas; Benoist, Guillaume
Interrompre une grossesse en réanimation sans recueil du consentement de la patiente : enjeux éthiques et médico-légaux Article de journal
Dans: Médecine Intensive Réanimation, vol. 31, no. 2, p. 77-84, 2022.
Résumé | Liens | BibTeX | Étiquettes: Collégialité, Droit des patients
@article{Moutel2022cc,
title = {Interrompre une grossesse en réanimation sans recueil du consentement de la patiente : enjeux éthiques et médico-légaux},
author = {Grégoire Moutel and Pauline Goupille and Bertille Suzat and Jean-Philippe Rigaud and Maud Charvin and Guillaume Grandazzi and Mylène Gouriot and Clément Gakuba and Thomas Gaberel and Guillaume Benoist},
doi = {10.37051/mir-00095},
year = {2022},
date = {2022-09-06},
urldate = {2022-09-06},
journal = {Médecine Intensive Réanimation},
volume = {31},
number = {2},
pages = {77-84},
abstract = {In France, the voluntary interruption of a pregnancy for medical reasons can be requested by the woman, whatever the term of the pregnancy, if it is attested that the continuation of the pregnancy seriously endangers her health. The termination of the pregnancy is then subject to the collegial opinion of a Pluridisciplinary Centre for Prenatal Diagnosis, which must give a favourable decision after analysing the situation. Following, it is the woman who takes the final decision. Respect for the autonomy of the pregnant woman is therefore a fundamental principle in prenatal diagnosis and termination of pregnancy in French law.
In this article, we analyse a situation that raises complex ethical and decision-making issues where the termination of pregnancy is required when the patient is neither able to formulate a request nor to consent, due to her pathology requiring hospitalization in intensive care.
If the continuation of the pregnancy poses a serious threat to the patient's health, urgency may be an acceptable argument for acting without the patient's consent. This urgency is understood here as the fact that, without a rapid decision, the clinical situation has little chance of improving or even deteriorating. In this context, we discuss the arguments for terminating the pregnancy and the importance of consulting the parents and spouse, so as not to exclude relatives from the decision-making process. Finally, our analysis questions the limits of medical secrecy in intensive care when a dialogue and an exchange of information with relatives appears essential, in particular when the patient cannot participate in the decision and when there are complex decisions to be made.},
keywords = {Collégialité, Droit des patients},
pubstate = {published},
tppubtype = {article}
}
In France, the voluntary interruption of a pregnancy for medical reasons can be requested by the woman, whatever the term of the pregnancy, if it is attested that the continuation of the pregnancy seriously endangers her health. The termination of the pregnancy is then subject to the collegial opinion of a Pluridisciplinary Centre for Prenatal Diagnosis, which must give a favourable decision after analysing the situation. Following, it is the woman who takes the final decision. Respect for the autonomy of the pregnant woman is therefore a fundamental principle in prenatal diagnosis and termination of pregnancy in French law.
In this article, we analyse a situation that raises complex ethical and decision-making issues where the termination of pregnancy is required when the patient is neither able to formulate a request nor to consent, due to her pathology requiring hospitalization in intensive care.
If the continuation of the pregnancy poses a serious threat to the patient's health, urgency may be an acceptable argument for acting without the patient's consent. This urgency is understood here as the fact that, without a rapid decision, the clinical situation has little chance of improving or even deteriorating. In this context, we discuss the arguments for terminating the pregnancy and the importance of consulting the parents and spouse, so as not to exclude relatives from the decision-making process. Finally, our analysis questions the limits of medical secrecy in intensive care when a dialogue and an exchange of information with relatives appears essential, in particular when the patient cannot participate in the decision and when there are complex decisions to be made.
In this article, we analyse a situation that raises complex ethical and decision-making issues where the termination of pregnancy is required when the patient is neither able to formulate a request nor to consent, due to her pathology requiring hospitalization in intensive care.
If the continuation of the pregnancy poses a serious threat to the patient's health, urgency may be an acceptable argument for acting without the patient's consent. This urgency is understood here as the fact that, without a rapid decision, the clinical situation has little chance of improving or even deteriorating. In this context, we discuss the arguments for terminating the pregnancy and the importance of consulting the parents and spouse, so as not to exclude relatives from the decision-making process. Finally, our analysis questions the limits of medical secrecy in intensive care when a dialogue and an exchange of information with relatives appears essential, in particular when the patient cannot participate in the decision and when there are complex decisions to be made.
2021
Rollet, Quentin; Bouvier, Véronique; Moutel, Grégoire; Launay, Ludivine; Bignon, Anne-Laure; Bouhier-Leporrier, Karine; Launoy, Guy; Lièvre, Astrid
Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival – a registry-based study Article de journal
Dans: BMC Health Services Research, vol. 21, no. 1032, 2021.
Résumé | Liens | BibTeX | Étiquettes: Collégialité
@article{Rollet2021,
title = {Multidisciplinary team meetings: are all patients presented and does it impact quality of care and survival – a registry-based study},
author = {Quentin Rollet and Véronique Bouvier and Grégoire Moutel and Ludivine Launay and Anne-Laure Bignon and Karine Bouhier-Leporrier and Guy Launoy and Astrid Lièvre},
doi = {https://doi.org/10.1186/s12913-021-07022-x},
year = {2021},
date = {2021-10-01},
urldate = {2021-10-01},
journal = {BMC Health Services Research},
volume = {21},
number = {1032},
abstract = {Background
Multidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs.
Aim
Identify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC).
Methods
3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the “Calvados Registry of Digestive Tumours” were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival.
Results
Non-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1–2.0], p < 0.001).
Conclusions
Elderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.},
keywords = {Collégialité},
pubstate = {published},
tppubtype = {article}
}
Background
Multidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs.
Aim
Identify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC).
Methods
3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the “Calvados Registry of Digestive Tumours” were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival.
Results
Non-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1–2.0], p < 0.001).
Conclusions
Elderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.
Multidisciplinary team meetings (MDTMs) are part of the standard cancer care process in many European countries. In France, they are a mandatory condition in the authorization system for cancer care administration, with the goal to ensure that all new patients diagnosed with cancer are presented in MDTMs.
Aim
Identify the factors associated with non-presentation or unknown presentation in MDTMs, and study the impact of presentation in MDTMs on quality of care and survival in patients diagnosed with colorectal cancer (CRC).
Methods
3999 CRC patients diagnosed between 2005 and 2014 in the area covered by the “Calvados Registry of Digestive Tumours” were included. Multivariate multinomial logistic regression was used to assess the factors associated with presentation in MDTMs. Univariate analyses were performed to study the impact of MDTMs on quality of care. Multivariate Cox model and the Log-Rank test were used to assess the impact of MDTMs on survival.
Results
Non-presentation or unknown presentation in MDTMs were associated with higher age at diagnosis, dying within 3 months after diagnosis, unknown metastatic status, non-metastatic cancer and colon cancer. Non-presentation was associated with a diagnosis after 2010. Unknown presentation was associated with a diagnosis before 2007 and a longer travel time to the reference care centres. Presentation in MDTMs was associated with more chemotherapy administration for patients with metastatic cancer and more adjuvant chemotherapy for patients with stage III colon cancer. After excluding poor prognosis patients, lower survival was significantly associated with higher age at diagnosis, unknown metastatic status or metastatic cancer, presence of comorbidities, rectal cancer and non-presentation in MDTMs (HR = 1.5 [1.1–2.0], p < 0.001).
Conclusions
Elderly and poor prognosis patients were less presented in MDTMs. Geriatric assessments before presentation in MDTMs were shown to improve care plan establishment. The 100% objective is not coherent if MDTMs are only to discuss diagnosis and curative cares. They could also be a place to discuss therapeutic limitations. MDTMs were associated with better treatment and longer survival. We must ensure that there is no inequity in presentation in MDTMs that could lead to a loss of chance for patients.