[The law number 2005-370 of April 22, 2005 concerning the patients' rights at the end-of-life: improvement of the withholding and withdrawing treatment decision-making process by an educational program. A monocenter prospective and retrospective pilot study].

Objective: To assess the impact of an educational program on the quality of the end-of-life decision (EOLD).

Methods: Prospective study for 3 months in a surgical Intensive Care Unit (ICU) involving: staff training conferences and guidelines for documenting level-of-care staff conference; audit before and at 3 months; analysis of records for deceased patients. The main outcome measures the proportion of treatment-limitation in dying ICU patients; and the secondary outcomes the decision-making process and nurses' satisfaction.

Results: Eighty-three patients were included; among them, 14 with EOLD. Pre-death palliative strategy increased from 51 % to 85 % with a persisting improvement of practices after 2 years. All steps of EOLD decision-making processes were traced in all such cases, 85 % being based on the proposed guidelines. Nursing team's satisfaction rate almost doubled to 70 %.

Discussion: The study demonstrate staff members' capacity to quickly improve their procedures for palliative care when provided with appropriate tools to think about the process and come to a decision. Our data suggest the potential benefice to extend this program to the other specialties involved in the end-of-life process.