Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emergency Departments
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.
To evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED.
Prospective observational multicenter study.
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.
GPs were interviewed about their perception of end of life patient’s management and the communication with ED and families.
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.
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
KEY WORDSgeneral practitioners emergency services decision-making terminal care primary care
Availability of Data and Material
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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.
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
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.
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