Study of the Consequences of Infection on Compliance of Modalities of Decisions of Limitations and Stops of Treatments (COVID-19-LAT)

Study Overview
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Brief Summary
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This survey is performed to examine if during the Covid's crisis, the practitionner's have respected the modalities of the law about the end of life, in particular concerning limitations and stop of therapeutics

Detailed Description
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In the current legislativ context notably the Clayes Leonetti law, a very large majority of ICU (Intensive Care Unit) patients die with the establishement of a procedure for the limitation and cessation of therapeutics (LAT). During a viral pandemic, medical resources can be saturated, limiting reflexive abilities in favour of binary decisions. This sorting of patients leads to LAT that could be performed without the elementary modalities stated by the law. Thus, arbitrary medical decisions made alone could expose patients to unjustified  loss of luck . Increasing the resources mobilized during a pandemic must not make us forget the quality of care provided for the benefit of quantity. In therefore seems legitimate to keep the LAT modalities to ensure our ethical principles. No work in the literature based on actual facts explores the impact of a pandemic on compliance with and maintenance of ethical principles and the legisltaive framework, in particular as regards the procedures of the application of LAT. The purpose of this study is to assess whether the terms of the LAT are being complied during a pandemic for patients with or without Covid.

Official Title
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Study of the Consequences of Infection on Compliance of Modalities of Decisions of Limitations and Stops of Treatments

Conditions
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Patient Hospitalized in Disease Infectious Unit, Patient Hospitalized in Intensive Reanimation Unit, Patient Hopsitalized in Internal Medicine Unit

Intervention / Treatment
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* Behavioral: decisions of limitations and stop processing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hospitalized major patient Infected or not with Covid-19 having a management with a LAT defined by an anticipated or factual restriction of a therapeutic resource ( organ replacement, specific treatment) while his or her state of health requires or may require it, leading or not a death. The patient's death occurs either after a cariac massagewhich corresponds to a maximum management with therapeutic failure or within the framework or in the context of brain death, in these cases there is no LAT ; either without cardiac massage and in this case there is de facto a LAT wether or not it is performed according to legisltaive procedures. All patients who die will beclassified according to this diagram for the inclusion criterion. For surviving patients, an analysis of the record in search of LAT elments will be performed. In the absence of LAT elment in the record, i twill be considered that the patient did not have LAT and therfore will not be included. Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patient 2019<br>Patients hospitalized in selected centers during march and june 2019 | Behavioral: decisions of limitations and stop processing<br>* Compliance of the modalities of decisions of limitations and stop processing<br>|
| Patient 2020<br>Patients hospitalized in selected centers during march and june 2020 (during COVID-19 pandemia) | Behavioral: decisions of limitations and stop processing<br>* Compliance of the modalities of decisions of limitations and stop processing<br>|
| Patient 2021<br>Patients hospitalized in selected centers during march and june 2021 | Behavioral: decisions of limitations and stop processing<br>* Compliance of the modalities of decisions of limitations and stop processing<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| decisions of limitations and therapeutic stops | The conformity of the modalities of the decisions of limitations and therapeutic stops will be evaluated by a composite criterion defined by the simultaneous presence of the 3 main modalities imposed by the Clayes-Leonetti law to achieve a limitation that are : An outside consultant's opinion ( required if no advance directives), the caregiver collegial discussion or adherence to patient advance directives, notification of decision in the medical record | at the end of patient's hospitalization, an average of one month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Characteristics of the notification of LAT procedure | notification of the decision, the conclusions of the discussions, the opinion of the consultant and the arguments given to justify the LAT | at the end of patient's hospitalization, an average of one month | 
| Characteristics of the LAT procedure (persons who participated to the collegial discussion) | number and status of caregivers who participated to the collegial discussion | at the end of patient's hospitalization, an average of one month | 
| Characteristics of consultant's reasoned opinion for the LAT procedure | formal elements of the consultant's reasoned opinion ( legal term) in the file | at the end of patient's hospitalization, an average of one month | 
| Characteristics of the LAT procedure | formal elements of advance directives | at the end of patient's hospitalization, an average of one month | 
| Characteristics of units | number of beds, number of caregivers (medical, paramedical, internal external), number of admissions during periods of study | day 0 | 
| Age of physicians | measured in year | Day 0 | 
| gendrer of physicians | male or female | Day 0 | 
| Exparience of physicians | Measured in year of experience | Day 0 | 
| Characteristics of physicians | professional status | Day 0 | 
| Age of patients | measured in year | day 0 | 
| patient's history | comorbidities | day 0 | 
| COVID-19 patient's status | COVID19 infection (yes or no) | day 0 | 
| Characteristics of hospitalization's patients | hospitalization reason | day 0 | 
| Characteristics of affected organ | organ failure | day 0 | 
| Characteristics of patients | severity score | day 0 | 
| final patient status | fate | day 0 | 
| patient's environnement | family presence or relatives | day 0 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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COVID 19, Limitations and stops of processing Active Therapeutic, ethics, Sanitary Crisis