Completion of a structured limitation of life-sustaining treatment decision form in the emergency department: a retrospective observational study

Abstract Background End-of-life care remains an intensive clinical intervention in many countries, including France, and a substantial proportion of deaths occur in hospitals and emergency departments. Decision-making regarding limitation or withdrawal of life-sustaining treatments in this context is complex. Structured documentation tools have been proposed to support decision-making and improve traceability. This study aimed to evaluate the completeness of a structured limitation-of-treatment decision form used in an emergency department. Methods We conducted a retrospective, descriptive, single-centre study in the emergency department of a French tertiary hospital. All adult patients for whom a limitation-of-treatment decision form was completed between January 2020 and March 2023 were included. The completeness of the forms was assessed using predefined key elements derived from national recommendations. Results Sixty-six forms were analysed. All four essential key elements were documented in 31.8% of cases (95% CI 21.8–43.8). Documentation rates were 84.8% for patient wishes (95% CI 74.3–91.6), 87.9% for collegial decision-making (95% CI 77.9–93.7), 60.5% for traceability (95% CI 51.2–69.2), and 50.0% for patient functional status (95% CI 38.3–61.7). Across the 15 variables included in the form, the mean completion rate was 72%. Conclusions Documentation of limitation-of-treatment decisions in the emergency department was generally satisfactory but remained incomplete for several key elements. Improving structured documentation tools and strengthening palliative care training may help enhance the quality of end-of-life decision-making in emergency settings. These findings highlight the importance of structured decision-support tools to improve the traceability and quality of end-of-life decisions in emergency care.