Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

George, Naomi; Barrett, Nina; McPeake, Laura; Goett, Rebecca; Anderson, Kelsey; Baird, Janette

doi:10.1111/acem.12710

Cited by 64 publications

(70 citation statements)

References 89 publications

(97 reference statements)

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“…Clinically recognizing disease prognosis and death trajectories as well as identifying the imminently dying patient were considered important since poorly informed physicians limit their ability to provide optimal, or even adequate, information to patients or families who may need to make difficult decisions. Early screening and rapid palliative care assessment are emerging topics with a growing body of evidence‐based research related to using toolkits and other skills to identify patients appropriate for palliative or hospice care . The topic of the ethnic, spiritual, and cultural aspects around end‐of‐life care and death were considered essential to introduce to residents, accepting that not many EM residencies provide their trainees with what is known about best practices.…”

Section: Resultsmentioning

confidence: 99%

Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework

Shoenberger

Lamba

Goett

et al. 2018

AEM Education and Training

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Section: Resultsmentioning

confidence: 99%

Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework

Shoenberger

Lamba

Goett

et al. 2018

AEM Education and Training

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“…However, we find that meeting the ‘gold standard’ can be aided by lists that reference the concept of ‘futility’ . There are a number of these, one example is represented in Table . Recent research has shown that the use of one such list is acceptable and reliable in the ED setting …”

Section: Initiating Planning In the Patient Approaching End‐of‐lifementioning

confidence: 99%

“…16 There are a number of these, one example is represented in Table 2. [17][18][19][20] Recent research has shown that the use of one such list is acceptable and reliable in the ED setting. 21 Emergency physicians have a critical circuit breaker role in: (i) identifying patients who would benefit from formal advance care planning; and then (ii) raising the issue at the appropriate time in a non-threatening way.…”

Section: Initiating Planning In the Patient Approaching End-of-lifementioning

confidence: 99%

Approach to death in the older emergency department patient

Arendts

Carpenter

Hullick

et al. 2016

Emerg Medicine Australasia

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“…( 22 ) Other more general screening tools can be applied to patients with ESLD, such as emergency‐department PC, which includes three simple criteria: (1) presence of a life‐limiting illness, (2) unmet PC needs (e.g., symptoms, functional decline, frailty, new onset of complications, limited social support), and (3) hospital admissions. ( 36 )…”

Section: Structures and Processes Required For Integrating Nonhospicementioning

confidence: 99%

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

2020

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Palliative care (PC) that has evolved from a focus on end-of-life care to an expanded form of holistic care at an early stage for patients with serious illnesses and their families is commonly referred to as nonhospice PC (or early PC). Patients with end-stage liver disease (ESLD) suffer from a high symptom burden and a deteriorated quality of life (QOL), with uncertain prognosis and limited treatment options. Caregivers of these patients also bear an emotional and physical burden similar to that of caregivers for patients with cancer. Despite the proven benefits of nonhospice PC for other serious illnesses and cancer, there are no evidence-based structures and processes to support its integration within the routine care of patients with ESLD and their caregivers. In this article, we review the current state of PC for ESLD and propose key structures and processes to integrate nonhospice PC within routine hepatology practice. Results found that PC is highly underutilized within ESLD care, and limited prospective studies are available to demonstrate methods to integrate PC within routine hepatology practices. Hepatology providers report lack of training to deliver PC along with no clear prognostic criteria on when to initiate PC. A well-informed model with key structures and processes for nonhospice PC integration would allow hepatology providers to improve clinical outcomes and QOL for patients with ESLD and reduce health care costs. Educating hepatology providers about PC principles and developing clear prognostic criteria for when and how to integrate PC on the basis of individual patient needs are the initial steps to inform the integration. The fields of nonhospice PC and hepatology have ample opportunities to partner clinically and academically. (Hepatology 2020;71:2149-2159). E nd-stage liver disease (ESLD) is the 12th leading cause of death and claims approximately 66,000 lives each year in the United States. (1) Between 2006 and 2016, the prevalence of ESLD increased by 7.9% among men 25-34 years of age and 11.4% among women in the same age group because of the increasing burden of nonalcoholic steatohepatitis, alcohol-associated liver disease, and advanced hepatitis C virus. (2) In parallel, mortality due to ESLD increased by 65% from 1999 to 2016. (3) ESLD is also associated with functional and cognitive impairment, often with concomitant mental health and substance use disorders. The physical and psychological symptom burden and social-role consequences of ESLD are often worse than those for many non-liver cancers. (4) The most frequently reported symptoms include pain, breathlessness, muscle cramps, sleep disturbance, fatigue, pruritus, anxiety, depression, and erectile dysfunction. (4) In addition to its direct effects on patients, ESLD is linked with a substantial caregiver emotional and physical burden, mirroring that observed in caregivers of patients with cancer. (5) However, interventions to improve the quality of life (QOL) for patients with ESLD and their caregivers are underdeveloped.Palliativ...

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Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

Cited by 64 publications

References 89 publications

Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework

Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework

Approach to death in the older emergency department patient

Nonhospice Palliative Care Within the Treatment of End‐Stage Liver Disease

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