District nurses' attitudes toward patient consent: The case of mechanical ventilation on amyotrophic lateral sclerosis patients: Results from a French national survey.

Abstract: Purpose: In France, a recent law emphasizes patient rights and prohibits unwanted therapies in end-of-life care. As end-of-life home care is increasing, we aimed to assess French district nurses'' attitudes toward terminally ill patients'' autonomy. Materials and Methods: We used data from a nationwide telephone survey conducted in 2005 among a random sample of French district nurses (n = 602). Nurses'' attitudes were assessed with a clinical case describing a patient (randomly defined as a male or a female aged 50 years) having amyotrophic lateral sclerosis (ALS) who urgently needs mechanical ventilation. Nurses were asked whether patient consent was necessary before performing intubation/tracheotomy, and the analysis took into account various covariates, including nurses'' religiosity, nurses'' attitudes toward living wills, and patient sex. Results: Overall, 44% of nurses considered that an ALS patient with respiratory failure should always be intubated (53% for a female patient, 40% for a male patient, P < .01), and after intubation, 27% upheld tracheotomy without considering patient consent as a necessary prerequisite (39% among male nurses, 30% among female nurses, P < .05). Poor communication with terminal patients and hostility toward living will were also predictive of willingness to perform both mechanical ventilation and tracheotomy without patient consent. Conclusions: A significant part of French district nurses may have a disturbing propensity to support intubation and tracheotomy with insufficient attention paid to the patient''s will. Further research should investigate potential causal factors (such as increased workload) as well as sex-related attitudes in nurse-patient relationship. [Copyright &y& Elsevier]