Shared Decision Making to Support the Provision of Palliative and End‐of‐Life Care in the Emergency Department: A Consensus Statement and Research Agenda

Abstract

Background: Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED).

Emergency department staff priorities for improving palliative care provision for older people: A qualitative study

“…Indeed, drawing clinicians, as well as patients into the decision-making processes, such as in this research, (28,29) is an approach increasingly recommended to get to the heart of challenges in ED-based palliative care. (46,47) Our findings also have implications for the broader palliative care community. Within the clinician experiences, willingness to bridge gaps in care delivery was hindered by a sense of isolation, both from the community and inpatient setting.…”

Review article: Goals‐of‐care discussions for adult patients nearing end of life in emergency departments: A systematic review

“…Many acutely unwell patients are assessed in EDs prior to hospital admission; therefore, ED practitioners might be wellplaced to have these discussions to ensure that beneficial treatments are provided and determine referral pathways (including to palliative services when indicated). [7][8][9] An ED-led goals-of-care discussion includes establishing trust, determining whether an ACP or surrogate decision-maker exists and determining patient care preferences. 10 Evidence regarding implementation of goals-of-care discussions in EDs is limited, and on commencing the present study, there were no systematic reviews on the topic.…”

Prognosis After Emergency Department Intubation to Inform Shared Decision‐Making

“…4 More than 70% of older adults with serious illness prioritize quality of life and quality of dying over longevity and consider some health states worse than death, 5 yet 56% to 99% of older adults do not have advance directives available at the time of emergency department (ED) presentation. 6 In 2016, the Society of Academic Emergency Medicine Consensus Conference released a consensus statement on the state of shared decision-making in the ED, 7 emphasizing that improving shared decision-making in palliative and end-of-life care is paramount to improving emergency care, but data available to guide shared decision-making in this setting are limited. Small sample size, [8][9][10] lack of focus on older adults, 11 focus on specific disease groups, 12,13 and lack of inclusion of individuals who died in the ED 15 have been limited prior studies of prognosis after emergency intubation.…”