Treatment of palliative care emergencies by prehospital emergency physicians in Germany: an interview based investigation

Abstract

Palliative care medical emergencies as a consequence of advanced cancer account for approximately 3% of all prehospital emergency cases. Therefore, prehospital emergency physicians (EP) are confronted with 'end of life decisions'. No educational content exists concerning palliative medicine in emergency medicine curricula. Over the course of 6 months, we interviewed 150 EPs about their experiences in 'end of life decisions' using a specific questionnaire. The total response rate was 69% (n = 104). Most of the interviewed EPs (89%, n = 93) had been confronted with palliative care medical emergencies and expressed uncertainties in dealing with these difficult situations, especially in the area of psychosocial care of the patients (50%). The emergency treatment of palliative care patients can become a particular challenge for any EP. A large percentage of interviewed EPs felt uncertain about aspects of social care and in the assessment of decisions at the end of life. Further information and training are necessary to amenable EPs to provide adequate patient-oriented care to palliative care patients and their relatives in emergency situations.

Evaluation of Terminal-Stage Cancer Patients Needing Palliative Care in the Emergency Department

“…A study by Mercadante et al (9) on palliative care patients reported that even phone consultations or intervention with a palliative care unit helps to reduce hospital admissions. In another study, it was stated that having a palliative care team reduces unnecessary ED admissions (10). Therefore, it is important for a hospital to establish a separate palliative care unit in order to respond to cancer patients' needs more effectively.…”

Emergencies in Patients With Advanced Cancer Followed at Home

“…Advanced training in palliative care medicine and end-of-life care should be integrated into emergency medical training. 3,4,8,11 It has been reported that patients seem to favor continuity of care and admission to an oncology ward directly. 12 As an alternative, a team of hospice nurse specialists, acting at the request of a well-recognized emergency system, can provide a concrete and useful response to problems of unwanted hospitalization in acute emergencies for home-based terminally ill patients.…”

“…The reasons for this usually concern legal uncertainties and unknown advance directives. 3,8,10 In Italy, it is unusual to provide advance directives. Of interest, there is a risk that any advance directive may not be taken into consideration according to a new law, which is being discussed and examined in the Italian Parliament.…”

“…Palliative care medical emergencies as a consequence of advanced cancer account for approximately 3% of all emergency medical service calls. 3 In the outof-hospital or emergency room arenas, no ideal palliative care models exist. For example, in the out-of-hospital setting, less than 6% of emergency medical systems have protocols in palliative care.…”

“…7 To avoid emergency situations and hospitalizations, support and responsibility should be shared with the palliative care team. 3 Ideally, the response to an emergency call should be managed by a team that knows the clinical situation and understands the typical home palliative care setting.…”