Inadequate involvement of general practitioners in end-of-life's decisions in an intensive care unit

Interests and objectives > Patients' general practitioners (GPs) could be relevant consultants for collegial decisions of withholding or withdrawing treatment (WWT) defined by the Leonetti law. We therefore studied their implication by intensivists in end-of-life decisions and collected their feelings. Their wishes for the coming law revision were also investigated. Methods > Retrospective descriptive study conducted in the polyvalent intensive care unit (ICU) of Longjumeau's hospital (France) using a distributed questionnaire to GPs of patients who benefited from collegial decisions of WWT in 2012. Results > The response rate was 60.4 % (32/53) and only 18.8 % of the respondents participated as a consultant in WWT's decision for their patient. Two GPs out of three reported that they never participate in such decisions for their others patients. All uninvolved GPs did not contribute because intensivists did not consult them. Only 43.7 % of GPs were contacted by intensivists during the stay and 21.9 % at the discharge or death of their patient. GPs took news about their patient during ICU hospitalization in 37.5 % of cases. Regarding uninvolved GPs, their participation could have changed WWT's decisions made for two patients (7.7 %). Most respondents felt available (78.1 %) and skilled (81.2 %) to participate in this kind of decision. A third was also questioned by the patient's family about it. Only 21.7 % of GPs report to be familiar with the French end-of-life legislation. In case of a next revision, two thirds considered important to make the use of GPs obligatory in such decisions. Conclusion > Despite an undeniable interest, GPs are rarely involved in collegial processes of WWT in ICUs, partially related to an insufficient knowledge of the law by the healthcare providers. At the dawn of end-of-life law's revision, their share could however improve our practices in this field.