• Philip G Richardson, Jaimi Greenslade, Jonathon Isoardi, Michael Davey, Mark Gillett, Alicia Tucker, Sharon Klim, Anne-Maree Kelly, and Ibrahim Abdelmahmoud.
• Emergency Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
• Emerg Med Australas. 2016 Dec 1; 28 (6): 684-690.

ObjectiveWe investigated and compared the importance of the considerations and discussions when withdrawing and withholding life-sustaining healthcare between emergency physicians (EP) and emergency registrars (ER).MethodsThis was a sub-study of a prospective cross-sectional questionnaire-based case series conducted in six EDs. Primary outcomes were, which of the discussion and considerations, were rated most important by EP and ER in the decision-making process.ResultsWe studied responses relating to the care of 320 patients, of which 49.4% were women and the median age was 83 (interquartile range [IQR] 72-88). EP and ER were sole decision-makers in 185 (39.7%) and 135 (30.0%) of cases, respectively. Treatment was withdrawn or withheld in 72.0 and 90.6% of all deaths by EP and ER, respectively (P < 0.001). EP and ER provided full treatment in 88 (34%) and 19 (12.7%) of cases, respectively (P < 0.05). The consideration rated most important was prognosis: 165 (90.2%, confidence interval: 85.0-93.7) and 121 (90.3%, confidence interval: 84.1-94.2) for EP and ER, respectively. ER rated co-morbidities and age more important than did EP (P < 0.05). Both rated discussions with family as very important. EP and ER referred 6.0% versus 11.9% patients to palliative care services, respectively. The proportion of patients taking longer than 24 h to die was higher for ER compared with that for EP (14.1% vs 4.9%, P < 0.05).ConclusionWe found that ER were more likely to withdraw/withhold life-sustaining healthcare, provide partial treatment, rate different considerations as important and their patients took longer to die than that of EP. Focused education and training might improve decision-making consistency between physicians and training registrars.© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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