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Un Modelo de Comunicación Para el Final de la Vida en un Servicio de Urgencias Tras Acontecimientos Devastadores Repentinos. Parte I: Acerca de la Capacidad Para la Toma de Decisiones, los Representantes Legales y las Directrices Avanzadas
Author(s) -
Limehouse Walter E.,
Ramana Feeser V.,
Bookman Kelly J.,
Derse Arthur
Publication year - 2012
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2012.01426.x
Subject(s) - medicine , emergency department , palliative care , psychological intervention , life support , medical emergency , advance care planning , intensive care medicine , nursing
ACADEMIC EMERGENCY MEDICINE 2012; 19: 1068–1072; © 2012 by the Society for Academic Emergency Medicine 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.