Interest of Pain Assessment by the Family of Patients in Limiting and Stopping Active Treatment Process Admitted in ER. Study DOFAMILA

Study Overview
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Brief Summary
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Decisions to limit and stop active therapeutics are common in the emergency unit. They are framed by the Leonetti law of 22 April 2005 recommending the refusal of unreasonable obstinacy and care of the patient's pain in later life. The pain assessment is an issue for these patients whose in majority, are not communicating. Moreover, no specific tool and the teams in charge, not knowing the patient make the recognition and treatment of pain symptoms very complex. This is the potential interest of directly involving the family or the person of confidence in this management , the first step being the detection and evaluation of pain.

Conditions
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Patient's Pain in Later Life

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults older than 18 non communicating patients admitted in emergency ward unanimous decision of stopping and limiting active treatment according to Leonetti's law of April 22nd, 2005 Presence of a member of the patients family or one of his legal representative Exclusion Criteria: Children no health insurance

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| simplified verbal scale | A simplified verbal scale with 5 levels used by caregivers and family to evaluate the intensity of pain, painless, little sore, moderately painful, very painful, extremely painful. Compare the pain assessment by the family or the person of trust and care teams within a population of non-communicating patients for whom a decision of limiting and stopping active treatment is taken emergency ward. | admission time in ER (Day 1) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| simplified verbal scale | A simplified verbal scale with 5 levels used by caregivers and family to evaluate the intensity of pain, painless, little sore, moderately painful, very painful, extremely painful . Compare the pain assessment by the family or the person of trust and care teams within a population of non-communicating patients 24 hours after the decision of limiting or stopping active treatment in emergencies | 24 hours after the decision of limiting or stopping active treatment in emergencies | 
| Algoplus scale | Comparison of pain assessment between families and caregivers with support will be made using Algoplus scale defining a pain when the score is greater than 2. Compare the pain assessment by the family or the person of trust and care teams with the support of a rating scale in a population of non-communicating patients for whom a decision of limiting or stopping active treatment in emergencies. | at admission (Day 1) | 
| PAINAD scale | Comparison of pain assessment between families and caregivers with support will be made using PAINAD scale rated from 0 to 10, defining the intensity of pain. Compare the pain assessment by the family or the person of trust and care teams with the support of a rating scale in a population of non-communicating patients for whom a decision of limiting or stopping active treatment in emergencies | at admission (Day 1) | 
| CAESAR scale | Assess the feelings of nursing teams on the family involvement in the assessment of pain and not communicating patient discomfort for which is a determination of limiting or stopping active treatment in emergencies. | 24 hours after admission | 
| CAESAR scale | The experience of the family will be described based on the questionnaire adapted from CAESAR scale ( rating scale of the quality of the care of the dying in intensive care) . Assess the feelings of nursing teams on the family involvement in the assessment of pain and not communicating patient discomfort for which is a determination of limiting or stopping active treatment in emergencies. | 3 weeks after admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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emergency treatment, arrest or limitation of active treatment