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

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 ch...

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Autores principales: Douplat, Marion, Fraticelli, Laurie, Claustre, Clement, Peiretti, Alexandra, Serre, Patrice, Bischoff, Magali, Jacquin, Laurent, Freyssenge, Julie, Schott, Anne-Marie, Tazarourte, Karim, Frugier, Soizic, Khoury, Carlos E. L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282105/
https://www.ncbi.nlm.nih.gov/pubmed/32513282
http://dx.doi.org/10.1186/s13049-020-00744-7
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author Douplat, Marion
Fraticelli, Laurie
Claustre, Clement
Peiretti, Alexandra
Serre, Patrice
Bischoff, Magali
Jacquin, Laurent
Freyssenge, Julie
Schott, Anne-Marie
Tazarourte, Karim
Frugier, Soizic
Khoury, Carlos E. L.
author_facet Douplat, Marion
Fraticelli, Laurie
Claustre, Clement
Peiretti, Alexandra
Serre, Patrice
Bischoff, Magali
Jacquin, Laurent
Freyssenge, Julie
Schott, Anne-Marie
Tazarourte, Karim
Frugier, Soizic
Khoury, Carlos E. L.
author_sort Douplat, Marion
collection PubMed
description 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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spelling pubmed-72821052020-06-10 Management of decision of withholding and withdrawing life-sustaining treatments in French EDs Douplat, Marion Fraticelli, Laurie Claustre, Clement Peiretti, Alexandra Serre, Patrice Bischoff, Magali Jacquin, Laurent Freyssenge, Julie Schott, Anne-Marie Tazarourte, Karim Frugier, Soizic Khoury, Carlos E. L. Scand J Trauma Resusc Emerg Med Original Research 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. BioMed Central 2020-06-08 /pmc/articles/PMC7282105/ /pubmed/32513282 http://dx.doi.org/10.1186/s13049-020-00744-7 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research
Douplat, Marion
Fraticelli, Laurie
Claustre, Clement
Peiretti, Alexandra
Serre, Patrice
Bischoff, Magali
Jacquin, Laurent
Freyssenge, Julie
Schott, Anne-Marie
Tazarourte, Karim
Frugier, Soizic
Khoury, Carlos E. L.
Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
title Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
title_full Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
title_fullStr Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
title_full_unstemmed Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
title_short Management of decision of withholding and withdrawing life-sustaining treatments in French EDs
title_sort management of decision of withholding and withdrawing life-sustaining treatments in french eds
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282105/
https://www.ncbi.nlm.nih.gov/pubmed/32513282
http://dx.doi.org/10.1186/s13049-020-00744-7
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