Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Dec;25(6):1193-1199.
doi: 10.1111/jep.13229. Epub 2019 Jul 9.

Difficulty of the decision-making process in emergency departments for end-of-life patients

Marion Douplat  1   2 , Julien Berthiller  3 , Anne-Marie Schott  3 , Véronique Potinet  1 , Pierre Le Coz  2 , Karim Tazarourte  4 , Laurent Jacquin  4
Affiliations
Multicenter Study

Difficulty of the decision-making process in emergency departments for end-of-life patients

Marion Douplat et al. J Eval Clin Pract. 2019 Dec.

Abstract

Background: In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life-sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision-making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients.

Aim: The purpose of this study is to describe the decision-making process of withholding and withdrawing life-sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients.

Design: We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017.

Results: We included 109 patients in the study. Fifty-eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life-sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision-making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died.

Conclusion: There is little anticipation in end-of-life decisions. Discussion with patients concerning their end-of-life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.

Keywords: advance directives; death; decision making; emergency service.

PubMed Disclaimer

References

REFERENCES

    1. Olsen JC, Bueneffe ML, Falco WD. Death in the emergency department. Ann Emerg Med. 1998;31(6):758-765.
    1. Le Conte P, Baron D, Trewick D, et al. Withholding and withdrawing life-support therapy in an emergency department: prospective survey. Intensive Care Med. 2004;30(12):2216-2221.
    1. Le Conte P, Riochet D, Batard E, et al. Death in emergency departments: a multicenter cross-sectional survey with analysis of withholding and withdrawing life support. Intensive Care Med. 2010;36(5):765-772.
    1. Damghi N, Belayachi J, Aggoug B, et al. Withholding and withdrawing life-sustaining therapy in a Moroccan emergency department: an observational study. BMC Emerg Med. 2011;11:12
    1. Ferrand E, Robert R, Ingrand P, Lemaire F, French LATAREA Group. Withholding and withdrawal of life support in intensive care units in France: a prospective survey. Lancet. 2001;357(9249):9-14.

Publication types

Grants and funding

LinkOut - more resources