End of Life Issues – Withdrawal of treatment/Decision to not treat in the Emergency Department: A prospective multi-centre study.

What factors are taken into account by doctors when making decisions regarding end of life care, and is this accordance with legislation?

Grant ID: EMSS-2008-006-RICHARDSON-END OF LIFE

Project Summary

Not infrequently, doctors working in the Emergency Department (ED) have to decide on how they are to provide treatment to dying patients. Specifically, they have to decide whether to actively treat or whether they should limit or withdraw treatment on patients who are not anticipated to live. Such decisions should be governed by legislature as well as standards set by the Australian Council on Health Care Standards (ACHCS). However, research conducted in our hospital has indicated that doctors consider a wide variety of factors including patient’s and family’s wishes when making such end-of-life decisions. We therefore raise the following questions. First, what factors do doctors take into account when they withdraw or withhold treatment in the ED? Second, are such decisions made in accordance with legislative requirements? To date, no research has examined this issue.

This study addresses this gap by focussing on the decisions leading to withdrawal of treatment in the ED. It is a multi-centre review of patients who die in 2009 in a number of Australian and New Zealand hospitals. The primary aim is to describe the factors that doctors consider when making the decisions to withdraw or withhold life-sustaining treatment. The secondary aims are to determine 1) whether Australian doctors are conducting such processes in line with ACHCS guidelines and 2) whether Queensland doctors are making such decisions in accordance with Queensland legislation.

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Outcomes

In a study of responses relating to the care of 320 patients, the team found that emergency registrars 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 emergency physicians. Focused education and training might improve decision-making consistency between physicians and training registrars.

In a comparison of the process of withdrawing and/or withholding life-sustaining-health-care between Emergency Physicians and Intensive Care Specialists, the team found that the majority of deaths that occurred a decision was made to withdraw and/or withhold life sustaining health care. Intensive care specialists were more likely to provide full treatment and their patients died more quickly than emergency physicians. Few patients were referred to a palliative care service.

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Dissemination

Richardson, P.G., Widdecombe, N. and Mahmoud, I., 2016. End-of-Life-Issues: Withdrawal and/or Withholding of Life Sus-taining Health Care: A Comparison between Emergency Physicians and Intensive Care Specialists. J Eme Med Int Care, 2(2), p.111.

Richardson, P.G., Greenslade, J., Isoardi, J., Davey, M., Gillett, M., Tucker, A., Klim, S., Kelly, A.M. and Abdelmahmoud, I., 2016. 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. Emergency Medicine Australasia, 28(6), pp.684-690.

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