Abstract
Barriers to Palliative Care in the Emergency Department (ED)—Results from a National Survey of Emergency Physicians (Sch413)
Journal of pain and symptom management, Vol.65(5), pp.e585-e586
05/2023
DOI: 10.1016/j.jpainsymman.2023.02.150
Abstract
1. Identify the most highly rated barriers preventing emergency physicians from initiating palliative care principles in the emergency department.
2. Develop collaborative interventions to improve access to palliative care for patients presenting to the emergency department.
More than half of older adults in the United States (US) will visit an ED in their last month of life. In 2022, the Joint Commission (TJC) issued a statement calling to “support efforts in the ED to incorporate palliative care.”
We surveyed US emergency medicine attending and resident physicians (EPs) to assess comfort levels discussing and initiating palliative care measures for ED patients. We collected both quantitative and qualitative responses. Respondents were recruited through the Council of Residency Directors in Emergency Medicine Listserv, requesting they share survey links with residents and faculty.
Of 149 responses, 68% were attendings and 32% trainees. Fifty-five percent reported seeing patients who could benefit from palliative care “at least weekly”; only 29% reported feeling “very comfortable” initiating conversations about palliative care. A lack of time was the highest-rated barrier to initiating end-of-life discussions while a lack of rapport and lack of specialized training were also highly rated as barriers. Fear of negative reactions from patients and colleagues and of malpractice were ranked lowly as barriers. On thematic analysis of the survey responses, we found that EPs are more comfortable discussing specific interventions (eg, resuscitation, intubation) than discussing bigger picture questions.
Our survey results suggest several avenues for responding to TJC's call to improve access to palliative care for ED patients: (1) Identify specific aspects of goals of care discussions squarely within the purview of EPs (eg, resuscitation preferences, treatment of nonsurvivable injuries, treatment of suffering). (2) Provide training to EPs on conducting these narrowly focused goals of care discussions. (3) Demonstrate to EPs that focused discussions of these specific aspects of palliative care that lay within their purview benefit patients and are feasible within the time constraints of an ED.
Details
- Title: Subtitle
- Barriers to Palliative Care in the Emergency Department (ED)—Results from a National Survey of Emergency Physicians (Sch413)
- Creators
- Daniel G. Miller - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of pain and symptom management, Vol.65(5), pp.e585-e586
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jpainsymman.2023.02.150
- ISSN
- 0885-3924
- eISSN
- 1873-6513
- Language
- English
- Date published
- 05/2023
- Academic Unit
- Internal Medicine; Emergency Medicine
- Record Identifier
- 9984388755502771
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