Who Am I to Decide Whether This Person Is to Die Today? Physicians’ Life-or-Death Decisions for Elderly Critically Ill Patients at the Emergency Department–ICU Interface: A Qualitative Study

Abstract

These qualitative findings highlight the cognitive heuristics and biases, interphysician conflicts, and communication gaps influencing physicians' triage and end-of-life decisions for elderly critically ill patients at the ED-ICU interface and suggest strategies to improve these decisions.

Promoting dignified end-of-life care in the emergency department: A qualitative study

“…(Pretorius et al, 2015)[31]. In line with other studies (Pringle et al, 2015)[32], the participants believe 13 that this training should reach all healthcare professionals -not only those who work in the ED, and it should include appropriate facilitating resources to face their own feelings with regard to death and dying (Norton et al, 2011) [27].…”

“…Similarly, other authors have insisted on the physicians' attitudes being paramount to quality of care [11] and on the need to take charge of spiritual matters in end-of-life care (Norton et al, 2011) [27].…”

“…In a technological environment, patients, family members and professionals face palliative sedation, futility of treatment [7] and the physician orders for life-sustaining treatment (POLST) [26,27]. The preservation of a dying person's dignity in the ED is fundamental for the patient, his/her relatives and healthcare professionals [28].…”

Resuscitating End-of-Life Care

“…In this month’s Annals , Fassier et al 6 present a methodologically sound qualitative study of the attitudes and thought processes of French emergency and critical care physicians caring for critically ill older adults. Through more than 300 hours of interviews with 24 physicians, linked to direct observation of decisionmaking, the authors provide a broad description of how physicians perceive these patients and interact with one another and how these perceptions and interactions influence care.…”

“…7 Improving the quality of communication between emergency physicians and admitting physicians, particularly critical care physicians, also makes sense. Echoing findings from both medical error and aviation safety research, Fassier et al 6 find that failures in communication during the admission of dying patients are not simply a failure to exchange information but are complicated by tensions caused by perceived or real hierarchic relationships. 8,9 As elsewhere in medicine, these tensions must be recognized and resolved to optimize patient care.…”