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Ethical issues encountered by French intensive care unit caregivers during the first COVID-19 outbreak

Problèmes éthiques rencontrés par les soignant·es des unités de soins intensifs en France lors de la première éclosion de COVID-19

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Abstract

Purpose

We aimed to describe the ethical issues encountered by health care workers during the first COVID-19 outbreak in French intensive care units (ICUs), and the factors associated with their emergence.

Methods

This descriptive multicentre survey study was conducted by distributing a questionnaire to 26 French ICUs, from 1 June to 1 October 2020. Physicians, residents, nurses, and orderlies who worked in an ICU during the first COVID-19 outbreak were included. Multiple logistic regression models were performed to identify the factors associated with ethical issues.

Results

Among the 4,670 questionnaires sent out, 1,188 responses were received, giving a participation rate of 25.4%. Overall, 953 participants (80.2%) reported experiencing issue(s) while caring for patients during the first COVID-19 outbreak. The most common issues encountered concerned the restriction of family visits in the ICU (91.7%) and the risk of contamination for health care workers (72.3%). Nurses and orderlies faced this latter issue more than physicians (adjusted odds ratio [ORa], 2.98; 95% confidence interval [CI], 1.87 to 4.76; P < 0.001 and ORa, 4.35; 95% CI, 2.08 to 9.12; P < 0.001, respectively). They also faced more the issue “act contrary to the patient's advance directives” (ORa, 4.59; 95% CI, 1.74 to 12.08; P < 0.01 and ORa, 10.65; 95% CI, 3.71 to 30.60; P < 0.001, respectively). A total of 1,132 (86.9%) respondents thought that ethics training should be better integrated into the initial training of health care workers.

Conclusion

Eight out of ten responding French ICU health care workers experienced ethical issues during the first COVID-19 outbreak. Identifying these issues is a first step towards anticipating and managing such issues, particularly in the context of potential future health crises.

Résumé

Objectif

Notre objectif était de décrire les enjeux éthiques rencontrés par les personnels de santé lors de la première éclosion de COVID-19 dans les unités de soins intensifs (USI) françaises, ainsi que les facteurs associés à leur apparition.

Méthode

Cette enquête multicentrique descriptive a été réalisée en distribuant un questionnaire à 26 unités de soins intensifs françaises, du 1er juin au 1er octobre 2020. Les médecins, les internes, le personnel infirmier et les aides-soignant·es qui travaillaient dans une unité de soins intensifs pendant la première éclosion de COVID-19 ont été inclus·es. Des modèles de régression logistique multiple ont été réalisés pour identifier les facteurs associés aux questions éthiques.

Résultats

Parmi les 4670 questionnaires envoyés, 1188 réponses ont été reçues, soit un taux de participation de 25,4 %. Dans l’ensemble, 953 personnes participantes (80,2 %) ont déclaré avoir éprouvé un ou des problèmes alors qu’elles s’occupaient de patient·es lors de la première éclosion de COVID-19. Les problèmatiques les plus fréquemment rencontrées concernaient la restriction des visites des familles dans les USI (91,7 %) et le risque de contamination pour les personnels de la santé (72,3 %). Le personnel infirmier et les aides-soignant·es étaient davantage confronté·es à ce dernier problème que les médecins (rapport de cotes ajusté [RCa], 2,98; intervalle de confiance [IC] à 95 %, 1,87 à 4,76; P < 0,001 et RCa, 4.35; IC 95 %, 2,08 à 9,12; P < 0,001, respectivement), tout comme ils étaient davantage confrontées à la question d’« agir contrairement aux directives médicales anticipées du/de la patient·e » (RCa, 4,59; IC 95 %, 1,74 à 12,08; P < 0,01 et RCa, 10,65; IC 95 %, 3,71 à 30,60; P < 0,001, respectivement). Au total, 1132 répondant·es (86,9 %) estimaient que la formation en éthique devrait être mieux intégrée à la formation initiale des personnels de santé.

Conclusion

Huit travailleuses et travailleurs de santé français·es des soins intensifs sur dix ont été confronté·es à des problèmes éthiques lors de la première éclosion de COVID-19. L’identification de ces enjeux est une première étape vers leur anticipation et leur gestion, en particulier dans le contexte d’éventuelles crises sanitaires futures.

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Author contributions

Corentin Therond, Marion Douplat, Pierre Le Coz, and Antoine Lamblin conceived and designed the study. Corentin Therond supervised the conduct of the study and data collection, undertook recruitment of participating centres, and managed the data, including quality control. Bérengère Saliba-Serre provided statistical advice on study design and analyzed the data. Corentin Therond drafted the manuscript. Marion Douplat, Pierre Le Coz, Béatrice Eon, Fabrice Michel, Vincent Piriou, Bérengère Saliba-Serre, and Antoine Lamblin contributed substantially to its revision. Corentin Therond takes responsibility for the manuscript as a whole.

Acknowledgements

We thank Véréna Landel (Direction de la Recherche en Santé, Hospices Civils de Lyon) for her help in manuscript preparation. We also thank Quenot Jean-Pierre, Belaïd Bouhemad, Jean-Marc Tadie, Marc Laffont, Arnaud Winer, Fabienne Tamion, Didier Gruson, Thierry Seguin, Alain Mercat, Marc Leone, Matthieu Jeannot, Mael Hamet, Grégoire Muller, Henry Lessire, Elisabeth Gaertner, Sébastien Beague, Jean-Pierre Bedos, Renaud Blonde, Guillaume Schnell, Karim Chaoui, Christophe Guitton, Clément Dubost, Eric Meaudre, Pierre Bouzat, Jerome Morel, Emmanuel Futier, Emmanuel Samain, Claude Eccofey, Francis Remerand, Paul Michel Mertes, Rebecca Clement, Vanessa Chatelin, Michel Carles, Christophe Baillard, Jean-Luc Hanouz, Bertrand Debaene, Xavier Capdevila, Vincent Minville, Laurent Beydon, Bertrand Rozec, Mohamed Malti, and Antonin Huguerot.

Disclosures

The authors declare no potential conflict of interest with respect to the research, authorship, and/or publication of this manuscript.

Funding statement

Not applicable.

Data availability

The data sets used and/or analyzed in the present study are available upon reasonable request to the corresponding author.

Editorial responsibility

This submission was handled by Dr. Alexis F. Turgeon, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. (UMR) Unité mixte de recherche 7268 ADES (Anthropologie bioculturelle, Droit, Ethique et Santé), CNRS (Centre Nationale de Recherche Scientifique), EFS (Etablissement Français du Sang), Aix-Marseille University, Marseille, France

    Corentin Therond MD, Bérengère Saliba-Serre MD, Pierre Le Coz PhD, Béatrice Eon MD, Fabrice Michel MD, PhD, Antoine Lamblin MD, PhD & Marion Douplat MD, PhD

  2. Direction Qualité Gestion des Risques/Cellule Qualité gestion des risques, AP–HM Hospital Timone, Marseille, France

    Béatrice Eon MD

  3. Service d’anesthésie et réanimation pédiatrique, AP–HM Hospital Timone, Marseille, France

    Fabrice Michel MD, PhD

  4. Service d’Anesthésie et de Réanimation, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France

    Vincent Piriou MD, PhD

  5. Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France

    Vincent Piriou MD, PhD & Marion Douplat MD, PhD

  6. Service civilo-militaire d’anesthésie-réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France

    Antoine Lamblin MD, PhD

  7. Service des Urgences de Lyon Sud, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France

    Marion Douplat MD, PhD

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  1. Corentin Therond MD
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Therond, C., Saliba-Serre, B., Le Coz, P. et al. Ethical issues encountered by French intensive care unit caregivers during the first COVID-19 outbreak. Can J Anesth/J Can Anesth 70, 1816–1827 (2023). https://doi.org/10.1007/s12630-023-02585-1

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