title: [Development of a tool for withholding and withdrawing life-sustaining treatment in the emergency room].
abstract: OBJECTIVE
  Active treatment withholding and withdrawing decisions in the emergency room (ER) must be taken collegially according to ethical and juridical statements. Specific tools can support this process and our main goal was to create and validate such a tool.
  
  
  METHODS
  We created a first version of a tool to help for treatment withholding and withdrawing decisions inspired by similar documents from literature. Every item of this tool was then assessed by a group of experts (ER physicians and nurses) using the Delphi method to reach a consensus.
  
  
  RESULTS
  Thirty-four experts from eleven ER (academic, regional centre) were included and participate to the first round and twenty-seven to the second round. From the eighty-two-item tool, sixty-five items reach a consensus during these two rounds and were kept to constitute the final version of the tool.
  
  
  CONCLUSIONS
  We have been able to create a tool to help for treatment withholding and withdrawing decisions adapted to the guidelines for end of life patient's management in the ER. This tool has been validated using a Delphi method by a group of experts from different centres. This multicentre validation will help for the diffusion and use of this tool in the different ER of the Rhône-Alpes region.
authors.affiliation: Centre de soins palliatifs Pavillon 1K, CHU de Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Institut de psychologie, université de Lyon 2, 69500 Bron, France.
authors.forename: A
authors.initials: A
authors.lastname: Chirac
authors.affiliation: Structure des urgences du CHU de Grenoble, 38700 La Tronche, France.
authors.forename: G
authors.initials: G
authors.lastname: David
authors.affiliation: Structure des urgences du CHU de Lyon-Sud, 69495 Pierre-Bénite cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Rieg
authors.affiliation: Information médicale évaluation recherche, hospices civils de Lyon, Lyon, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Schott-Pethelaz
authors.affiliation: Service de réanimation médicale, CHU de Lyon-Sud, hospices civils de Lyon, 69495 Pierre-Bénite cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Bohe
authors.affiliation: Structure des urgences du CHU de Grenoble, 38700 La Tronche, France.
authors.forename: F
authors.initials: F
authors.lastname: Carpentier
authors.affiliation: Structure des urgences du CHU de Lyon-Sud, 69495 Pierre-Bénite cedex, France.
authors.forename: X
authors.initials: X
authors.lastname: Jacob
authors.affiliation: Centre de soins palliatifs Pavillon 1K, CHU de Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
authors.forename: W
authors.initials: W
authors.lastname: Rhondali
authors.affiliation: Centre de soins palliatifs Pavillon 1K, CHU de Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France. Electronic address: marilene.filbet@chu-lyon.fr.
authors.forename: M
authors.initials: M
authors.lastname: Filbet
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032921:Consensus; D003697:Delphi Technique; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D028761:Withholding Treatment / Q000592:standards*
keywords: Delphi technique; Emergency service; Fin de vie; Limitation et arrêt des traitements; Méthode Delphi; Terminally ill; Urgences; Withholding and withdrawing life-sustaining treatment