Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emerge
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Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, Pierre Bénite, France; 2Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, Marseille, France; 3Hôpital de Vienne, Service d’Accueil des urgences, Vienne, France; 4Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France; 5Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, Lyon, France.
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 Balways^ 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. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05464-y) contains supplementary material, which is available to authorized users. Received November 13, 2018 Accepted September 30, 2019
NIH TRIAL REGISTRY NUMBER: NCT02844972 KEY WORDS: general practitioners; emergency services; decision-making; terminal care; primary care. J Gen Intern Med DOI: 10.1007/s11606-019-05464-y © Society of General Internal Medicine 2019
INTRODUCTION
Most deaths in emergency departments (ED) are preceded by a decision of withholding or withdrawing life-sustaining treatments and most of these patients are unable to communicate their wishes or participate in the decision.1–3 The context of emerg
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