• Elie Azoulay, Frédéric Pochard, Sylvie Chevret, Christophe Adrie, Djilali Annane, Gérard Bleichner, Caroline Bornstain, Yves Bouffard, Yves Cohen, Marc Feissel, Dany Goldgran-Toledano, Christophe Guitton, Jan Hayon, Esther Iglesias, Luc-Marie Joly, Mercé Jourdain, Christian Laplace, Christine Lebert, Juliette Pingat, Catherine Poisson, Anne Renault, Olivier Sanchez, Dominique Selcer, Jean-François Timsit, Jean-Roger Le Gall, Benoît Schlemmer, and FAMIREA Study Group.
• Intensive Care Unit of the Saint-Louis Teaching Hospital and University of Paris 7, Assistance Publique-Hôpitaux de Paris, Paris, France.
• Crit. Care Med. 2004 Sep 1;32(9):1832-8.

ObjectiveTo evaluate the opinions of intensive care unit staff and family members about family participation in decisions about patients in intensive care units in France, a country where the approach of physicians to patients and families has been described as paternalistic.DesignProspective multiple-center survey of intensive care unit staff and family members.SettingSeventy-eight intensive care units in university-affiliated hospitals in France.PatientsWe studied 357 consecutive patients hospitalized in the 78 intensive care units and included in the study starting on May 1, 2001, with five patients included per intensive care unit.InterventionsWe recorded opinions and experience about family participation in medical decision making. Comprehension, satisfaction, and Hospital Anxiety and Depression Scale scores were determined in family members.Measurements And Main ResultsPoor comprehension was noted in 35% of family members. Satisfaction was good but anxiety was noted in 73% and depression in 35% of family members. Among intensive care unit staff members, 91% of physicians and 83% of nonphysicians believed that participation in decision making should be offered to families; however, only 39% had actually involved family members in decisions. A desire to share in decision making was expressed by only 47% of family members. Only 15% of family members actually shared in decision making. Effectiveness of information influenced this desire.ConclusionIntensive care unit staff should seek to determine how much autonomy families want. Staff members must strive to identify practical and psychological obstacles that may limit their ability to promote autonomy. Finally, they must develop interventions and attitudes capable of empowering families.

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