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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, August 11, 2016

End-of-Life Discussions in the ED

ACEP Now - August 9, 2016 - By DeSandre P; Fairbrother H; Rosenberg M; and Jesus J
"The emergency department is a setting in which medicine is practiced with limited time and information and where relationships with patients are stressed and fleeting. By themselves, these variables present significant challenges to patient-physician communication regarding outcomes of critical interventions. This is especially true of the critically ill patient, who may or may not have the cognitive capacity and wherewithal to meaningfully participate in conversation.
There are numerous challenges to communicating realistic outcomes of critical, often end-of-life (EOL) care interventions. Initial patient expectations of treatment benefit may be wildly inaccurate, with one study reporting patient estimate of survival after cardiopulmonary resuscitation (CPR) as high as 60 percent, closely matching the survival rates of patients after CPR on television. Moreover, physicians are generally poor prognosticators, particularly in the terminally ill population. For example, physicians are generally far too optimistic about their patients’ chances of survival. It should then come as no surprise that physicians are inadequately trained to make prognoses and have EOL care discussions and frequently avoid the discussion altogether. When providers do approach patients, they often do so by asking about lifesaving interventions it has taken health care providers years of professional development to understand, without assessing patients’ goals of care, sometimes leading to discrepancies between patient preferences and the care provided to them. Finally, if patients lack decision-making capacity, there is no guarantee family members can represent the patients’ preferences, which they do accurately just 68 percent of the time..."