Advertisement

Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emergency Departments

  • Marion DouplatEmail author
  • Khadidja Daoud
  • Julien Berthiller
  • Anne-Marie Schott
  • Véronique Potinet
  • Pierre Le Coz
  • Karim Tazarourte
  • Laurent Jacquin
Article

Abstract

Background

Decisions of withholding or withdrawing life-sustaining treatment are frequent in emergency departments (ED) and patients are often unable to communicate their wishes concerning end of life desires.

Objective

To evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED.

Design

Prospective observational multicenter study.

Patients

We included patients for whom a decision of withdrawing or withholding life-sustaining treatments was made in ED. For each patient, we enrolled one general practitioner.

Main Measures

GPs were interviewed about their perception of end of life patient’s management and the communication with ED and families.

Key Results

There were 109 potential patient participants. We obtained answers from 54 (49.5%) of the patient’s associated GPs. Only 4 (7.4%) GPs were involved during the decision-making process of withholding or withdrawing life-sustaining treatments. Among GPs, 29 (53.7%) were contacted by family after the decision, most often to talk about their difficult experience with the decision. A majority (94%) believed their involvements in these decisions were important and 68% wished to “always” participate in end of life decisions despite the fact that they usually don’t participate in these decisions. Finally, 66% of GPs believed that management of end of life in the emergency department was a failure and should be anticipated.

Conclusions

GPs would like to be more involved and barriers to GP involvement need to be overcome. We do not have any outcome data to suggest that routine involvement of GPs in all end of life patients improves their outcomes. Moreover, it requires major system and process-based changes to involve all primary care physicians in ED decision-making.

NIH Trial Registry Number

NCT02844972

KEY WORDS

general practitioners emergency services decision-making terminal care primary care 

Notes

Availability of Data and Material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ Contributions

MD, LJ conceived the study, designed the trial, and obtained research funding. MD, KD, LJ, and KT supervised the conduct of the trial and data collection. MD, LJ undertook recruitment of participating centers and patients and managed the data, including quality control. JB and LJ provided statistical advice on study design and analyzed the data. MD drafted the manuscript, and all authors contributed substantially to its revision. MD takes responsibility for the paper as a whole. All authors read and approved the final manuscript.

Funding Information

The study was financed by the APICIL FOUNDATION. The institution “Hospices Civils de Lyon” received the funds for data management and analysis.

Compliance with Ethical Standards

Conflict interest

The authors declare that they do not have a conflict of interest.

Ethics Approval and Consent to Participate

The study was approved by the ethics committee of the University Hospital of Lyon on March 12th, 2015.

Supplementary material

11606_2019_5464_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 16 kb)

References

  1. 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 Dec; 30(12):2216-21.CrossRefGoogle Scholar
  2. 2.
    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 May; 36(5):765-72.CrossRefGoogle Scholar
  3. 3.
    Damghi N, Belayachi J, Aggoug B, Dendane T, et al. Withholding and withdrawing life-sustaining therapy in a Moroccan Emergency Department: an observational study. BMC Emerg Med. 2011 Aug 12;11:12.CrossRefGoogle Scholar
  4. 4.
    Douplat M, Jacquin L, Tazarourte K, Michelet P, Le Coz P, Physicians’ experience in decisions of withholding and withdrawing life-sustaining treatments: a multicentre survey into emergency departments, Anaesthesia Critical Care and Pain Medicine (2018) Dec;37(6):633-634CrossRefGoogle Scholar
  5. 5.
    Wall J, Hiestand B, Caterino J (2015) Epidemiology of Advance Directives in Extended Care Facility Patients Presenting to the Emergency Department. West J Emerg Med 16:966–973.CrossRefGoogle Scholar
  6. 6.
    Ferrand E, Jabre P, Fernandez-Curiel S, et al. Participation of French general practitioners in end of life decisions for their hospitalised patients. J Med Ethics. 2006 Dec;32(12):683-7.CrossRefGoogle Scholar
  7. 7.
    Evans N, Costantini M, Pasman H.R, End of Life Communication: A Retrospective Survey of Representative General Practitioner Networks in Four Countries. J Pain Symptom Manage. 2014 Mar; 47(3): 604-19.CrossRefGoogle Scholar
  8. 8.
    Lamahewa K, Mathew R, Iliffe S, Wilcock J, Manthorpe J, Sampson EL, Davies N. A qualitative study exploring the difficulties influencing decision making at the end of life for people with dementia. Health Expect. 2018 Feb;21(1):118-127.CrossRefGoogle Scholar
  9. 9.
    A.-L Feral –Pierssens. T Boulain. F Carpentier. P. Le Borgne Withholding and withdrawing life-sustaining therapies from adult patients in emergency care. Ann. Fr. Med. Urgences (2018) 8 :246-251.Google Scholar
  10. 10.
    European Recommendations for End-of-Life Care for Adults in Departments of Emergency Medicine. EUSEM. 2017.Google Scholar
  11. 11.
    Royal College of Emergency Medicine. End of Life Care for Adults in the Emergency Department. London, March 2015.Google Scholar
  12. 12.
    Chan GK. End-of-life models and emergency department care. Acad Emerg Med. 2004; 11(1):79-86.CrossRefGoogle Scholar
  13. 13.
    Olsen JC, Bueneffe ML, Falco WD. Death in the emergency department. Ann Emerg Med. 19.Google Scholar
  14. 14.
    Beauchamp TL, Childress J. Principles of Biomedical Ethics (5e édition), New-York/Oxford, Oxford University Press, 2001.98; 31(6):758-765.Google Scholar
  15. 15.
    Douplat M, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Difficulty of the decision-making process in emergency departments for end of life patients. J Eval Clin Pract. 2019 Jul 9.Google Scholar
  16. 16.
    Slort W, Schweitzer BP, Blankenstein AH, et al. Perceived barriers and facilitators for general practitioner-patient communication in palliative care: a systematic review. Palliat Med. 2011 Sep;25(6):613-29.CrossRefGoogle Scholar
  17. 17.
    Slort W, Blankenstein AH, Deliens L, van der Horst HE. Facilitators and barriers for GP-patient communication in palliative care: a qualitative study among GPs, patients, and end-of-life consultants. Br J Gen Pract. 2011 Apr;61(585):167-72.CrossRefGoogle Scholar
  18. 18.
    Lane N, Bragg MJ. From emergency department to general practitioner: evaluating emergency department communication and service to general practitioners. Emerg Med Australas. 2007;19:346–352.PubMedGoogle Scholar
  19. 19.
    Montalto M, Harris P, Rosengarten P. Impact of general practitioners' referral letters to an emergency department. Aust Fam Physician. 1994;23:1320–1321.PubMedGoogle Scholar
  20. 20.
    Rubin, W, Sarnoff, J. (1986). Sudden unexpected death: intervention with the survivors. Ann Emerg Med. 15, 99–102.Google Scholar
  21. 21.
    Walters DT, Tupin JP. Family grief in the emergency department. Emerg Med Clin North Am. 1991 Feb;9(1):189-206.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Marion Douplat
    • 1
    • 2
    Email author
  • Khadidja Daoud
    • 3
  • Julien Berthiller
    • 4
  • Anne-Marie Schott
    • 4
  • Véronique Potinet
    • 1
  • Pierre Le Coz
    • 2
  • Karim Tazarourte
    • 5
  • Laurent Jacquin
    • 5
  1. 1.Hospices Civils de LyonHôpital Lyon Sud, Service d’Accueil des urgencesPierre BéniteFrance
  2. 2.Aix-Marseille Université/EFS/CNRSUMR 7268 ADéS, Faculté de MédecineMarseilleFrance
  3. 3.Hôpital de VienneService d’Accueil des urgencesVienneFrance
  4. 4.Pôle Information Médicale Evaluation RechercheHospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425LyonFrance
  5. 5.Hospices Civils de Lyon Hôpital Edouard Herriot, Service d’Accueil des urgencesLyonFrance

Personalised recommendations