Understanding patients’ end‐of‐life goals of care in the emergency department

Swenson, Aunika; Hyde, Robert J.

doi:10.1002/emp2.12388

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…[13][14][15] Furthermore, much of the available emergency care research regarding older adults' patient-centered goals currently focuses on treating clinicians performing end-of-life goals of care conversations. [16][17][18] However, ED treating clinicians are tasked with navigating older adult priorities not just during critical illness or end of life.…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of “What Matters” to Older Adults in the Emergency Department

Gettel

Venkatesh

Dowd

et al. 2022

WestJEM

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Introduction: The “4Ms” model – What Matters, Medication, Mentation, and Mobility – is increasingly gaining attention in age-friendly health systems, yet a feasible approach to identifying what matters to older adults in the emergency department (ED) is lacking. Adapting the “What Matters” questions to the ED setting, we sought to describe the concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians. Methods: We conducted 46 dyadic semi-structured interviews of cognitively intact older adults and their treating clinicians. We used the “What Matters” conversation guide to explore patients’ 1) concerns and 2) desired outcomes. We then asked analogous questions to each patient’s treating clinician regarding the patient’s priorities. Interviews were professionally transcribed and coded using an inductive approach of thematic analysis to identify emergent themes. Results: Interviews with older adults lasted a mean of three minutes, with a range of 1–8 minutes. Regarding patients’ concerns, five themes emerged from older adults: 1) concern through a family member or outpatient clinician recommendation; 2) no concern, with a high degree of trust in the healthcare system; 3) concerns regarding symptom cause identification; 4) concerns regarding symptom resolution; and 5) concerns regarding preservation of their current status. Regarding desired outcomes, five priority themes emerged among older adults: 1) obtaining a diagnosis; 2) returning to their home environment; 3) reducing or resolving symptoms; 4) maintaining self-care and independence; and 5) gaining reassurance. Responding to what they believed mattered most to older adult patients, ED clinicians believed that older adults were concerned primarily about symptom cause identification and resolution and primarily desired a return to the home environment and symptom reduction. Conclusion: This work identifies concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians as well as the feasibility of incorporating the “What Matters” questions within ED clinical practice.

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Section: Introductionmentioning

confidence: 99%

A Qualitative Study of “What Matters” to Older Adults in the Emergency Department

Gettel

Venkatesh

Dowd

et al. 2022

WestJEM

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“…Provision of end-of-life care in the ED is fraught with challenges [ 11 , 38 ]. Emergency medicine training often adopts a “save-all” mentality.…”

Section: Discussionmentioning

confidence: 99%

“…End-of-life care in the ED is rapidly gaining importance as the ageing population increases globally [ 10 , 11 ]. However, existing literature provides limited information regarding patients’ and families’ experiences of ED end-of-life management [ 12 ], and perspectives and barriers experienced by ED and community healthcare professionals [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals—A Qualitative Analysis

et al. 2023

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Background and Objectives: End-of-life care in the emergency department (ED) is gaining importance along with the growth in the ageing population and those with chronic and terminal diseases. To explore key stakeholders’ perspectives and experiences regarding end-of-life care in the ED. Materials and Methods: A descriptive qualitative study was conducted from November 2019 to January 2020. Study participants were recruited from the EDs of three tertiary hospitals and community care settings in Singapore through purposive sampling. Data collection included focus group discussions with 36 ED staff, 16 community healthcare professionals, and one-on-one semi-structured interviews with seven family members. Results: Three main themes and several subthemes emerged from the data analysis. (1) Reasons for ED visits were attributed to patients’ preferences, families’ decisions, limited services and capabilities in the community, and ease of access. (2) Barriers to providing end-of-life management in the ED included: conflicting priorities of staff, cramped environment, low confidence, ineffective communication, and lack of standardised workflows. (3) Discussion about continuity of end-of-life care beyond the ED uncovered issues related to delayed transfer to inpatient wards, challenging coordination of terminal discharge from the ED, and limited resources for end-of-life care in the community. Conclusions: Key stakeholders reported challenges and shared expectations in the provision of end-of-life care in the ED, which could be optimised by multidisciplinary collaborations addressing environmental factors and workflows in the ED. Equipping ED physicians and nurses with the necessary knowledge and skills is important to increase competency and confidence in managing patients attending the ED at the end of their lives.

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“…The whole group of patients aged 70 years or older had a median of three comorbidities and a median clinical frailty score of three. It would have been relevant to have had conversations about values and preferences with more patients from this group, as research has shown discordance between physicians’ assessment of patient goal of care with the patients’ own goals of care [ 41 ]. The current study aimed to explore the levels of limitation decisions and shared decision-making, but in future studies, it will be relevant to include patient involvement in decisions about full treatment, including transfer to an ICU.…”

Section: Discussionmentioning

confidence: 99%

Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

Jensen

Ozden

Kristensen

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions. Methods A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality. Results A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement. Conclusions Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.

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Understanding patients’ end‐of‐life goals of care in the emergency department

Cited by 6 publications

References 12 publications

A Qualitative Study of “What Matters” to Older Adults in the Emergency Department

A Qualitative Study of “What Matters” to Older Adults in the Emergency Department

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals—A Qualitative Analysis

Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

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