Hospice and Palliative Medicine: New Subspecialty, New Opportunities

Quest, Tammie E.; Marco, Catherine A.; Derse, Arthur R.

doi:10.1016/j.annemergmed.2008.11.019

Cited by 96 publications

(96 citation statements)

References 82 publications

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“…This is due to a variety of factors including: patient and family emotional distress (Gordon et al, 2010); lack of staff access to relevant patient information (Kelley et al, 2011); challenging conversations about goals of care (Grudzen et al, 2012a, Nobar andLisk, 2014); and environmental factors such as noise, time limitations, demands of other patients and lack of privacy (Bailey et al, 2011a, Beckstrand et al, 2008. Different approaches to improving the quality of palliative care delivered in a non-traditional palliative care environment include: initiation of palliative care consultations in the ED (Lamba et al, 2014); creating older person-only units (Hwang and Morrison, 2007); and closer collaboration between EDs and palliative care teams (Quest et al, 2009). An approach not previously implemented is that of enabling collaborative working between patients, family caregivers and healthcare staff in designing ED-based palliative care services.…”

Section: Introductionmentioning

confidence: 99%

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes

Blackwell

Lowton

Robert

et al. 2017

International Journal of Nursing Studies

120

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Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: a reflective critique on the process and outcomes.International Journal of Nursing Studies http://dx.doi.org/10. 1016/j.ijnurstu.2017.01.002 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of -and preferences for -palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting.Objectives: To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work.Setting: an Emergency Department in a large teaching hospital in the United Kingdom.Methods: Experience-based Co-design incorporating: 150 hours of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members.Findings: the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patientfamily-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Codesign in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process.Conclusion: Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable p...

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Section: Introductionmentioning

confidence: 99%

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes

Blackwell

Lowton

Robert

et al. 2017

International Journal of Nursing Studies

120

View full text Add to dashboard Cite

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“…Care for patients approaching the end of life is the subject of increasing attention in the U.S. health care system, as evidenced by the growth of hospice care and recognition of the new specialty of palliative medicine. 49,50 End-of-life issues arise in the ED when patients present with end-of-life symptoms, with terminal conditions requiring palliative care, or in cardiac arrest. Over 139,000 patients die in EDs annually (0.12% of ED visits).…”

Section: Health Care Reform and End-of-life Carementioning

confidence: 99%

The Ethics of Health Care Reform: Impact on Emergency Medicine

Marco

Moskop

Schears

et al. 2012

Academic Emergency Medicine

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The recent enactment of the Patient Protection and Affordable Care Act (ACA) of 2010, and the ongoing debate over reform of the U.S. health care system, raise numerous important ethical issues. This article reviews basic provisions of the ACA; examines underlying moral and policy issues in the U.S. health care reform debate; and addresses health care reform's likely effects on access to care, emergency department (ED) crowding, and end-of-life care. The article concludes with several suggested actions that emergency physicians (EPs) should take to contribute to the success of health care reform in America.

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“…The core skills required of EPs have been outlined elsewhere. 23 The specialty of EM needs to be and is committed to educating our specialists in embracing the communication and technical skills needed to provide excellent care and continuity for hospice patients.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Ethics Seminar: The Hospice Patient in the ED: An Ethical Approach to Understanding Barriers and Improving Care

Zieske

Abbott²

2011

Academic Emergency Medicine

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Emergency physicians (EPs) are asked to evaluate and treat a growing population of hospice patients who present to the emergency department (ED) for a number of important reasons. Hospice patients pose unique ethical challenges, and ''best practices'' for these patients can differ from the life-preserving interventions of usual ED care. Having a solid understanding of professional responsibilities and ethical principles is useful for guiding EP management of these patients. In end-of-life care, EPs need to recognize that there are barriers and complexities to the best management of hospice patients, but they need to commit to strategies that optimize their care.This article describes the case of a hospice patient who presented with sepsis and end-stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life.ACADEMIC EMERGENCY MEDICINE 2011; 18:1201-1207 ª 2011 by the Society for Academic Emergency Medicine M edical management of hospice patients requires nuanced diagnostic and treatment decisions that are less straightforward than typical emergency department (ED) care. The best approach to each hospice patient is achieved when emergency physicians (EPs) understand the ethical principles on which their professional responsibilities are based. We present the case of a hospice patient who arrived in extremis to the ED and review the ethical principles surrounding hospice care. We also highlight the barriers that occurred with this patient and barriers that are often seen in other ED hospice situations. Principles and practical steps are recommended to help guide EPs toward achieving the best care for hospice patients in the rapid tempo of the ED. CASE VIGNETTEHM was a 35-year-old Vietnamese male with metastatic lung cancer brought to the ED by ambulance during a busy overnight shift. His chief concern was ''chest, abdominal, and flank pain.'' This patient was well known to the staff and had presented to our ED with similar complaints three times over the prior 3 weeks. His cancer was advanced, with brain, liver, pancreas, and bone metastases. His medical record indicated that he had failed an aggressive chemotherapy regimen and had undergone whole brain radiation and gamma knife therapy since his diagnosis 18 months before the current presentation.The patient had been enrolled in a hospice program approximately 1 week prior to this visit through an oncologist at another hospital. He had visited the ED most recently 2 days earlier and was noted to be in pain, tachycardic, and febrile. A chest radiograph, urinalysis, blood, and urine cultures were obtained, but the judgment of the ED staff at that time was that admission for further workup of his fever was not in line with his palliative goals of care. He was discharged home after the EPs contacted his home hospice nu...

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Hospice and Palliative Medicine: New Subspecialty, New Opportunities

Cited by 96 publications

References 82 publications

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes

Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes

The Ethics of Health Care Reform: Impact on Emergency Medicine

Ethics Seminar: The Hospice Patient in the ED: An Ethical Approach to Understanding Barriers and Improving Care

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