Faculty Collaboration Database

A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives. Acad Emerg Med 2012 Sep;19(9):E1068-72

Date

09/18/2012

Pubmed ID

22978734

DOI

10.1111/j.1553-2712.2012.01426.x

Scopus ID

2-s2.0-84866389813 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to implement shared decisions.

Author List

Limehouse WE, Feeser VR, Bookman KJ, Derse A

Author

Arthur R. Derse MD, JD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Advance Care Planning
Advance Directives
Communication
Critical Illness
Decision Making
Emergency Medicine
Emergency Service, Hospital
Female
Humans
Informed Consent
Models, Organizational
Quality Control
United States