• Mélanie Chastrusse, Jean-Pierre Fulgencio, Florence Julien, Brice Naudin, Vincent Argo, Francis Bonnet, and Edouard Ferrand.
• Hôpital Foch, service d'anesthésie, 92150 Suresnes, France.
• Presse Med. 2012 Oct 1;41(10):e539-46.

ObjectiveTo assess the impact of an educational program on the quality of the end-of-life decision (EOLD).MethodsProspective study for 3 months in a surgical Intensive Care Unit (ICU) involving: staff training conferences and guidelines for documenting level-of-care staff conference; audit before and at 3 months; analysis of records for deceased patients. The main outcome measures the proportion of treatment-limitation in dying ICU patients; and the secondary outcomes the decision-making process and nurses' satisfaction.ResultsEighty-three patients were included; among them, 14 with EOLD. Pre-death palliative strategy increased from 51 % to 85 % with a persisting improvement of practices after 2 years. All steps of EOLD decision-making processes were traced in all such cases, 85 % being based on the proposed guidelines. Nursing team's satisfaction rate almost doubled to 70 %.DiscussionThe study demonstrate staff members' capacity to quickly improve their procedures for palliative care when provided with appropriate tools to think about the process and come to a decision. Our data suggest the potential benefice to extend this program to the other specialties involved in the end-of-life process.Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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