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. 2020 Jun 8;28(1):52.
doi: 10.1186/s13049-020-00744-7.

Management of decision of withholding and withdrawing life-sustaining treatments in French EDs

Marion Douplat  1   2 , Laurie Fraticelli  3   4 , Clement Claustre  3 , Alexandra Peiretti  3 , Patrice Serre  3   5 , Magali Bischoff  3 , Laurent Jacquin  6 , Julie Freyssenge  3   7   8 , Anne-Marie Schott  7   9 , Karim Tazarourte  6   7 , Soizic Frugier  10 , Carlos E L Khoury  3   7 ; LAT group
Collaborators, Affiliations

Management of decision of withholding and withdrawing life-sustaining treatments in French EDs

Marion Douplat et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Decisions of withholding or withdrawing life sustaining-treatments in emergency department are part of current practice but the decision-making process remains poorly described in the literature.

Study objective: We conducted a study in two phases, the first comprising a retrospective chart review study of patients dying in the ED and the second comprising survey study of health care workers at 10 urban emergency departments in France.

Method: In a first step, we analyzed medical records based on fifteen criteria of the decision-making process grouped into four categories: the collegiality, the traceability, the management and the communication as recommended by the international guidelines. In a second step, we conducted an auto-administrated survey to assess how the staff members (medical, paramedical) feel with the decision-making process.

Results: There were 273 deaths which occurred in the ED over the study period and we included 145 (53.1%) patients. The first-step analysis revealed that the traceability of the decision and the information given to patient or the relatives were the most reported points according to the recommendations. Three of the ten emergency departments had developed a written procedure. The collegial discussion and the traceability of the prognosis assessment were significantly increased in emergency department with a written procedure as well as management of pain, comfort care, and the communication with the patient or the relatives. In the second-step analysis, among the 735 staff members asked to take part in the survey, 287 (39.0%) answered. The medical and paramedical staff expressed difficult experience regarding the announcement and the communication with the patient and the relatives.

Conclusion: The management of the decision to withhold or withdraw life-sustaining treatments must be improved in emergency departments according to the guidelines. A standard written procedure could be useful in clinical practice despite the lack of experienced difference between centers with and without procedures.

Keywords: Decision making; emergency service; Health personnel; Palliative care.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Fig. 1
Fig. 1
Geographic area of the RESUVal network
Fig. 2
Fig. 2
Fifteen criteria grouped in four categories for analyzing the decision-making process
Fig. 3
Fig. 3
Trial profile of patients admitted to emergency departments during study period
Fig. 4
Fig. 4
Decision-making modalities based on fifteen criteria according to the presence of a procedure or not
Fig. 5
Fig. 5
Experience of the management by the medical and paramedical staff according to the presence of a procedure or not
See this image and copyright information in PMC

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