End‐of‐life issues: Withdrawal and withholding of life‐sustaining healthcare in the emergency department: A comparison between emergency physicians and emergency registrars: A sub‐study. (4th October 2016)

• Record Type: Journal Article
• Authors: Richardson, Philip G; Greenslade, Jaimi; Isoardi, Jonathon; Davey, Michael; Gillett, Mark; Tucker, Alicia; Klim, Sharon; Kelly, Anne‐Maree; Abdelmahmoud, Ibrahim
• Is Part Of: Emergency medicine Australasia. Volume 28:Number 6(2016:Dec.)
• Page Start: 684
• Page End: 690
• Publication Date: 2016-10-04
• Subjects: death -- emergency department -- end‐of‐life care; Emergency medicine -- Periodicals; Emergency medicine -- Australasia -- Periodicals; 616.025
• DOI: 10.1111/1742-6723.12684
• Languages: English
• ISSNs: 1742-6731

Abstract

Abstract: Objective: We investigated and compared the importance of the considerations and discussions when withdrawing and withholding life‐sustaining healthcare between emergency physicians (EP) and emergency registrars (ER). Methods: This was a sub‐study of a prospective cross‐sectional questionnaire‐based case series conducted in six EDs. Primary outcomes were, which of the discussion and considerations, were rated most important by EP and ER in the decision‐making process. Results: We studied responses relating to the care of 320 patients, of which 49.4% were women and the median age was 83 (interquartile range [IQR] 72–88). EP and ER were sole decision‐makers in 185 (39.7%) and 135 (30.0%) of cases, respectively. Treatment was withdrawn or withheld in 72.0 and 90.6% of all deaths by EP and ER, respectively ( P < 0.001). EP and ER provided full treatment in 88 (34%) and 19 (12.7%) of cases, respectively ( P < 0.05). The consideration rated most important was prognosis: 165 (90.2%, confidence interval: 85.0–93.7) and 121 (90.3%, confidence interval: 84.1–94.2) for EP and ER, respectively. ER rated co‐morbidities and age more important than did EP ( P < 0.05). Both rated discussions with family as very important. EP and ER referred 6.0% versus 11.9% patients to palliative care services, respectively. The proportion of patients taking longer than 24 h to die was higher for ER compared with that for EP (14.1% vs 4.9%, P < 0.05). Conclusion: We found that ER were more likely to withdraw/withhold life‐sustaining healthcare, provide partial treatment, rate different considerations as important and their patients took longer to die than that of EP. Focused education and training might improve decision‐making consistency between physicians and training registrars.