Abstract
Objective
This study explored the therapeutic approaches used for end-of-life (EOL) patients
admitted to the emergency department (ED) and examined whether the decision to perform
life-extending treatment (LET) or to allow natural death (AND) depends on patient
characteristics, medical staff variables, and ED setting.
Methods
A retrospective archive study was conducted from January 2015 to December 2017 in
the ED of a tertiary hospital. The study sample were 674 EOL patients who had died
in the ED. For each patient, data were collected and measured for dying process (LET
vs. AND), patient characteristics, ED-setting variables, and medical-staff characteristics.
Results
The proportion of EOL patients undergoing LET increased from 18.1% in 2015 to 25.9%
in 2016 and to 30.3% in 2017 (p = .010), and a quarter of them were treated by emergency
medical services. Males tended to receive LET more than females (p < .001). An association
was found between Jewish physicians and nurses and AND (p = .001). Heavier workload
in the ED and greater severity of the triage classification predicted more LET (OR-1.67,
CI = 1.05–1.76, p = .003 and OR = 1.42, CI-0.60-0.81, p < .001, respectively). Receiver
operating characteristic analysis showed that patient characteristics contributed
most crucially to the therapeutic approaches (C statistic 0.624–0.675, CI-0.62-0.71).
Conclusions
The therapeutic approach used for EOL patients in the ED depends on variables in all
three treatment layers: patient, medical staff, and ED setting. Applicable national
programs should be developed to ensure that no external factors influence the dying-process
decision.
Keywords
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Article Info
Publication History
Published online: August 13, 2018
Accepted:
August 13,
2018
Received in revised form:
July 29,
2018
Received:
June 5,
2018
Footnotes
☆The research has not been presented.
☆☆No financial support was received for this research.
★All authors attest to meeting the ICMJE.org authorship criteria.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
