Medical perspectives regarding goals-of-care consultations in Emergency Departments

Levinson, Michele; Walker, Katie; Hanning, Jennifer; Dunlop, William A; Cheong, Edward; Mills, Amber

doi:10.1080/13548506.2019.1595683

Cited by 8 publications

(26 citation statements)

References 16 publications

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“…28 The findings in this study were consistent with the previous research regarding the understanding that ACP was not beneficial for decision making at the EOL, and recommendations to change ACP to goals of patient care, which were made at the point of care and current prognosis, were emphasized. 28 Limitations identified include the subjective nature of the research. The findings cannot be generalized; however, they may be transferrable to other ED settings.…”

Section: Discussionsupporting

confidence: 89%

Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department

Omoya

Bellis

Breaden

2022

J Hosp Palliat Nurs

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There have been significant advancements in the fields of medicine, demography, and pathology. These disciplines have contributed to the classification and control of death and dying. People are now living longer with numerous comorbidities, and there is a significant aging population. Consequently, there have been increases in the numbers of people who present to emergency departments across Australia seeking access to care at the end of life. Emergency department staff must have the knowledge and skills required to provide end-of-life care in a setting that traditionally contradicts the goals of comfort care. With the increase in demand for end-of-life care in emergency departments, a gap exists in the experiences of how staff provide such care in this setting. As a result of this gap, it is important to understand the lived experiences of emergency department doctors and nurses who provide end-of-life care. The aim of this research is to understand the lived experiences of emergency department doctors and nurses concerning death, dying, and end-of-life care provision. Data were analyzed using Diekelmann's 7-step analysis to support Gadamer's phenomenological approach. Results indicate that challenges exist in the decision-making process of end-of-life care in emergency departments.

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Section: Discussionsupporting

confidence: 89%

Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department

Omoya

Bellis

Breaden

2022

J Hosp Palliat Nurs

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“…Indeed, standardization of communication and training for clinicians is found to have been associated with improved end-of-life care conversations. 21,25,28,30,39-41 Promoting consensus building on clinical definitions of medically futile treatment in cardiology would enable guideline-concordant care and mitigate end-of-life futile treatment. 21,25,28,30,39,40…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Potentially Futile Treatments at the End of Life in a Multiethnic Asian Cardiology Setting: A Qualitative Study

Yoon

Neo

et al. 2021

Am J Hosp Palliat Care

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Background. Modern medicine enables clinicians to save lives and prolong time to death, yet some treatments have little chance of conferring meaningful benefits for patients nearing the end-of-life. What clinicians perceive as driving futile treatment in the non-Western healthcare context is poorly understood. Aim. This study aimed to explore clinicians’ perceptions of the factors that influence futile treatment at the end of life within a tertiary hospital cardiac care setting. Design. We conducted semi-structured interviews with cardiologists, cardiac surgeons, and palliative care doctors from a large national cardiology center in Singapore. Interviews were transcribed verbatim and thematically analyzed. Results. A total of 32 clinicians were interviewed. We identified factors that contributed to the provision of potentially futile treatment in these theme areas: patient- and family-related, clinician-related, and institutional and societal factors. Family roles and cultural influences were most commonly cited by participants as affecting end-of-life decisions and altering the likelihood of futile treatment. Specialty-specific alignments within cardiology and availability of healthcare resources were also important factors underpinning futile treatment. Conclusion. Family-related factors were a primary driver for futile treatment in a non-Western, multicultural setting. Future interventions should consider a targeted approach accounting for cultural and contextual factors to prevent and reduce futile treatment.

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“…When CDM was operationalized as cognition, disposition decisions, or a model, studies overall found that an aid improved performance, in terms of decisions that are more accurate and lower uncertainty [21,38,40,[61][62][63][64][65][66][67][68].…”

Section: Effects Of Aidsmentioning

confidence: 99%

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

et al. 2020

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Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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Medical perspectives regarding goals-of-care consultations in Emergency Departments

Cited by 8 publications

References 16 publications

Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department

Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department

Factors Influencing Potentially Futile Treatments at the End of Life in a Multiethnic Asian Cardiology Setting: A Qualitative Study

Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

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