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163 Co-construction with partner families of a protocol for announcing the decision of withholding or withdrawing life-sustaining treatments in the emergency departements
  1. Mathilde Marchal1,2,
  2. Manon Verroul2,
  3. Anne Termoz1,2,
  4. Pauline Drouin2,
  5. Julie Haesebaert1,2,
  6. Marion Douplat1,2,3
  1. 1Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
  2. 2Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
  3. 3Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des Urgences, Lyon, France

Abstract

Introduction The context for an announcement of withholding and withdrawing life-sustaining treatments in emergency departments (ED) is complex. Indeed, the lack of time and places in these units may increase the stress and anxiety of families who are unprepared for this announcement. To improve the experience of families and shift towards patients and family centered practices, we co- construct a new announcement protocol with partner families.

Methods A participatory action research was conducted. Semi-structured interviews were carried out to enable families to share their experiences and have a personal space to express themselves, given the emotional charge. Then 3 workshops were conducted to work on elements borrowed from their experience, to be included in a training course on the announcement of limitation and cessation of therapies in the ED, aimed at healthcare professionnal. The workshops were audio recorded and a qualitative analysis was conducted.

Results We conducted 8 interviews and recruited 11 families passing through various ED to participate in workshops. In the interviews, participants were able to share their experiences. During the workshops, families were able to retrace their loved one’s care pathway and the difficulties encountered. Scenarios were drawn up based on the announcements to these partner families, for role-playing during the training course, as well as 3 testimonial videos for healthcare professionnals. The booklet to be distributed to families in ED has been reread and modified.

Discussion The participatory action research conducted in partnership with families enabled us to construct an intervention to improve ED professionals’ skills for a family centered announcement of the decision of withholding or withdrawing life-sustaining treatments through training.

Conclusion We identified the obstacles and facilitating factors for implementing the intervention and validated the formation. The next step will be to assess the intervention within a randomized study.

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