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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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01-12-2020 | Care | Original research

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

Authors: Marion Douplat, Laurie Fraticelli, Clement Claustre, Alexandra Peiretti, Patrice Serre, Magali Bischoff, Laurent Jacquin, Julie Freyssenge, Anne-Marie Schott, Karim Tazarourte, Soizic Frugier, Carlos E. L. Khoury, The LAT group

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2020

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.

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Title: Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
Authors: Marion Douplat
Laurie Fraticelli
Clement Claustre
Alexandra Peiretti
Patrice Serre
Magali Bischoff
Laurent Jacquin
Julie Freyssenge
Anne-Marie Schott
Karim Tazarourte
Soizic Frugier
Carlos E. L. Khoury
The LAT group
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Care
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2020
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-020-00744-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Study objective

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Study objective

Method

Results

Conclusion

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