Attitudes and educational needs of emergency doctors providing palliative and end-of-life care in Hong Kong: a cross-sectional analysis based on a self-report study

Abstract

Background Due to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas. Methods A questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services. Results In total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics. Conclusions The study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future.

Palliative care in the emergency department: An observational study of doctors in KwaZulu-Natal

“…Physicians with better knowledge had more positive attitudes in other studies, and it is suggested that training in PC concepts and symptom management contributed to better attitudes and willingness to provide PC when needed. 16 , 18 , 19 , 22 , 27 Other factors that may contribute to positive attitudes are participants’ exposure in managing patients with terminal illness in their clinical practice and clinicians’ position in the care team. 28 The need for PC services in the ED is growing and doctors in the ED are faced with patients in need of PC regularly.…”

“…A number of studies have looked at the PC competence of EM physicians. 16 , 21 , 22 It has been found that inadequate knowledge, inaccessibility of PC services and a lack of protocols and PC teams and specialists contributed to unfavourable attitudes of many ED clinicians 16 ; correspondingly, physician training in the principles of PC is needed to achieve high-quality PC provision, especially in the areas of non-pain related physical symptoms and psychological symptoms. 16 , 22 …”

Experiences of Australian emergency doctors and nurses using advance care directives in the provision of care at the end of life

“…9,28,33,34 Results of these studies indicate that nurses in ED have an expressed interest in taking an active role in helping patients at the end of life clarify their preferences. 35,36 A recent scoping review of articles exploring nurse led ACD training showed that there were numerous training modules available for nurses and doctors. 31 ED nurses and doctors require formal training in initiating end-of-life communication and difficult discussions so that they can improve the quality of care for patients who may require endof-life care rather than futile active treatment.…”

“…Recent studies exploring ED nurse led initiated conversations at the end of life showed improved communications between patients and clinicians 9,28,33,34 . Results of these studies indicate that nurses in ED have an expressed interest in taking an active role in helping patients at the end of life clarify their preferences 35,36 . A recent scoping review of articles exploring nurse led ACD training showed that there were numerous training modules available for nurses and doctors 31 .…”