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Objectives: End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU.Design: Qualitative study with clinical interviews. All interviews were transcribed verbatim and analyzed thematically using interpretative phenomenological analysis.Setting: Two independent ICUs at the "Centre Hospitalier de l'Université de Montréal."Subjects: Ten physicians and 10 nurses.Interventions: None.Measurements and Main Results: During the end-of-life decision-making process, families and patients restructure the decision-making frame by introducing a strong emotional dimension. This results in the emergence of new challenges quite different from the immediacy often associated with intensive care. In response to changes in decision frames, physicians rely on their relationship with the patient's family to assist with advanced care decisions. Nurses, however, draw on their relationship and proximity to the patient to denounce therapeutic obstinacy.Conclusions: Our study suggests that during the end-of-life decision-making process, nurses' feelings toward their patients and physicians' feelings toward their patients' families influence the decisions they make. Although these emotional dimensions allow nurses and physicians to act in a manner that is consistent with their professional ethics, the professionals themselves seem to have a poor understanding of these dimensions and often overlook them, thus hindering collegial decisions. [ABSTRACT FROM AUTHOR]

L'entrée en Établissement d'Hébergement pour Personnes âgées dépendantes est porteuse de nombreux bouleversements pour la personne âgée. Les études menées sur ce sujet démontrent que le souhait de mourir est une demande exprimée par un nombre non négligeable de malades en fin de vie, quelle que soit la législation adoptée par les pays. L'étude DESAGE est une étude qualitative multicentrique qui a pour objectif de décrire, analyser et comprendre les déterminants des demandes d'euthanasie et de suicide assisté chez les résidents de ces structures. Des résidents ont été rencontrés dans le cadre d'entretiens semi-directifs. Une souffrance, qu'elle soit physique ou psychologique, est présente dans les discours et la mort est perçue comme la seule solution pour soulager cet éprouvé. De multiples facteurs la sous-tendent : la dépendance, la difficulté à trouver du sens à sa vie actuelle, la solitude, le sentiment d'ennui, l'impression d'être un poids pour ses proches. Elle est également mise en lien avec la crainte d'une dégradation de l'état physique et l'appréhension des conditions de fin de vie. Elle s'enracine dans un vécu marqué par les pertes successives, parfois brutales. L'analyse du discours permet d'obtenir des clés de compréhension pour les soignants. C'est une assignation à trouver dans l'échange des enjeux communs. Le discours d'une personne qui demande à mourir est une tentative d'expression de l'indicible, une tentative d'expression d'une souffrance singulière. Moving into a nursing home is the cause of considerable upheaval for the elderly. The end of life is a reality in these establishments and residents are regularly confronted with it. Death is part of life in a nursing home and at the same time, it is one of the least discussed subjects due to avoidance strategies. The desire to die can take many forms, from suicide to refusal of care, and it is studied in particular through an analysis of requests for euthanasia and assisted suicide. The studies conducted on this subject show that the wish to die is a request expressed by a significant number of patients at the end of their life, regardless of the legislation adopted by the countries. Few studies have analyzed the demand for euthanasia or assisted suicide in a country where it is prohibited. A qualitative study is needed to provide an in-depth analysis of the expressions used by residents who make a request for euthanasia or assisted suicide, in the specific context of nursing homes. The DESAGE study (Demandes d'Euthanasie et de Suicide Assisté des personnes Âgées) is a multi-centric qualitative study which aims to describe, analyze, and understand, through semi-directive interviews, the determinants of requests for euthanasia and assisted suicide among residents of these facilities. This research is part of a comprehensive approach to these requests based on the residents' verbatim statements. The data collection was carried out in several nursing homes in a region of eastern France near Switzerland. For inclusion in the study to be effective, explicit requests for assistance in dying had to be made to health professionals. Following inclusion, an initial semi-directive interview of the resident was conducted. A second interview took place several weeks later to understand the timing of such a request. The analysis of the data followed the logic of thematic content analysis. Data collection took place from May 2019 to July 2021 in seven nursing homes in France. Seven situations were explored. These testimonies shed light on the reality of a little-investigated field and highlight meaningful life pathways. The testimonies of these individual inform us about the requests for euthanasia and assisted suicide that are made, and undeniably place them in a singular context. Suffering, whether physical or psychological, is present in the statements and death is perceived as the only solution to relieve this suffering. Multiple factors underlie it: dependence, the difficulty of finding meaning in one's current life, loneliness, the feeling of boredom, the impression of being a burden on one's loved ones. It is also linked to the fear of a deterioration of the physical state and the apprehension of the conditions at the end of life. It is rooted in an experience marked by successive, sometimes brutal, losses: physical losses linked to ageing, the loss of autonomy, the loss of reference points in the initial environment when entering a nursing home, and in some cases the loss of a spouse or main caregiver. It would be relevant to introduce into the daily practice of caregivers the implementation of more tools that promote, for example, the deployment of the function of restraint. Focusing on taking care of the body could be an illustration of this, because when we enhance the body, we also enhance the psyche. Moreover, the analysis of the discourse makes it possible to provide the caregivers with keys to understanding. It is an assignment to find common issues in the exchange. It is in this space of speech that the answers can be found and that an importance is given to the understanding of a common construct. The speech of a person who asks to die is an attempt to express the unspeakable, an attempt to express a singular suffering. It is essential to question the function of speech, what is at stake, and to train caregivers to confront these issues. [ABSTRACT FROM AUTHOR]

Background: Medical progress and the lifestyle modification have prolonged life expectancy, despite the development of chronic diseases. Support and care for older subjects are often provided by a network of informal caregivers composed of family, friends and neighbors, who are essential in helping older persons to continue living at home. It has been shown that the extent and diversity of informal tasks may jeopardize the physical, mental and social wellbeing of caregivers.Methods/design: The aim of the Informal Carers of Elderly cohort is to define, through a longitudinal study, profiles of caregivers of older patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colorectal), neurodegenerative diseases (Parkinson's disease, Alzheimer's disease and similar diseases), neurovascular diseases (stroke), sensory diseases (age-related macular degeneration (AMD)) and heart disease (heart failure). Patients must be at least 60 years old and living in the region of Burgundy-Franche-Comte (France). By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers, coping strategies, levels of anxiety and depression, social support and the extent of their burden. We will also evaluate the efficacy and efficiency of the implementation of a pragmatic intervention by a social worker to help informal caregivers, through a randomized interventional trial nested in the cohort. Qualitative approaches aimed at studying the caregiver/patient relationship, and situations leading to breakdown of the caregiver relationship will be also undertaken.Discussion: Through an analytical and longitudinal definition of profiles of informal caregivers, this study will gather detailed information on their life courses and their health trajectory by identifying consequences associated with the concept of their role as carers. In addition, the randomized interventional trial will explore the relevance of the implementation of a supportive intervention by a social worker to help caregivers. These data will help to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support adapted to caregivers, and provide an impulse for new health care policies.Trial Registration: ClinicalTrials.gov Identifier: NCT02626377 . Retrospectively registered on 9 December 2015. Protocol date/version: 23 October 2014/version 2. [ABSTRACT FROM AUTHOR]