That was a game changer: clinical impact of an emergency department-based palliative care communication skills training workshop

Abstract

ObjectiveTo explore the impact of an adapted goals-of-care communications skills workshop created for ED physicians from the physicians’ perspective.MethodsSemi-structured, one-on-one audio-recorded interviews lasting 30–60 min were conducted with twelve physicians who had completed the training workshop. Interviews explored the experience of undertaking the workshop, its impact on their clinical practice and their ability to teach new skills to other clinicians using learnt techniques. Descriptive content analysis was performed on interview transcripts.ResultsParticipants reported positive experiences of the workshop. The analysis identified four main themes and ten subthemes dealing with workshop content and its impact on subsequent ED-based clinical practice. There were: 1) value and future improvements for the course; 2) value of the course to practice; 3) value of the course for teaching residents and 4) barriers to application of learning. Specifically recommended components include the use of mnemonics, mechanisms to introduce difficult conversations and a positive feedback environment. Participant-recommended refinements to the workshop included emphasising urgency, replicating the chaotic ED environment and expanding content to include more ED-focused goals-of-care discussions.ConclusionA short, focused training workshop directed at improving palliative care communication skills among ED clinicians appears to be welcomed and useful.

Mapping the future for research in emergency medicine palliative care: A research roadmap

“…The first related to understanding the value imperative for PC in EM , with a focus on expanding on the limited literature currently available on the perspectives of patients, 37,46,82–84 communities, and clinicians not previously identified through research (including PC providers, subspecialists, social workers, and case managers). The second gap that emerged related to models of care delivery with a need to build and test new interventions and to further investigate the limited literature on issues surrounding care delivery in the context of workforce development 85,86 . The third gap related to disparities , specifically understanding the prevalence, contributing factors and best strategies to mitigate them.…”

“…As researchers consider the value drivers for different stakeholders, it will be important to parse out how these drivers differ in different contexts. In particular, there is an opportunity to create a more clear understanding of what the unique value imperatives were that drove the rapid increase in ED–PC integration during COVID 12,13,48,85,87,88 and how many of these programs remain relevant after the pandemic recedes.…”

“…As researchers consider the value drivers for different stakeholders, it will be important to parse out how these drivers differ in different contexts. In particular, there is an opportunity to create a more clear understanding of what the unique value imperatives were that drove the rapid increase in ED-PC integration during COVID 12,13,48,85,87,88 and how many of these programs remain relevant after the pandemic recedes. This body of research will build on the limited work that has tried to quantify impact 20,23 and can focus not only on what the models are but also on increasing knowledge around the process for the prioritization of different models, which will help create a way for leaders to match the right models to the right environments and populations.…”

Attitude toward end-of-life care in emergency medicine residents- can a short workshop make a difference?

“…Goldonowicz et al, in 2018, described that simulation was an effective tool for learning PC [ 18 ]. Wright et al in 2019 used an ED-based PC communication skills training workshop and showed it is beneficial for residents’ approach to patients and instructing PC skills to learners [ 19 ]. An Australian study by Jelinek et al showed that even brief exposure of a single day appears to change ED clinicians’ attitude and practice in PC [ 20 ].…”

Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea

“…However, environmental constraints make it unreasonable to conduct palliative care consultations with all ED patients. Here, suggested augmentations include screening criteria [ 58 ], training to recognize triggers [ 59 ], EOL management protocols [ 28 ], palliative care training courses [ 60 , 61 ], and short-stay observation units [ 62 ]. ED physicians and palliative care specialists can also work toward a mutual understanding of their respective priorities, expectations, and management flow pressures [ 58 , 63 – 66 ].…”