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End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives

INTRODUCTION: End-of-life (EOL) conditions are commonly encountered by emergency physicians (EP). We aim to explore EPs’ experience and perspectives toward EOL discussions in acute settings. METHODS: A qualitative survey was conducted among EPs in three tertiary institutions. Data on demographics, E...

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Autores principales: Zhang, Yuan Helen, De Silva, Muthuwadura Waruni Subashini, Allen, John Carson, Lateef, Fatimah, Omar, Eunizar Binte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006716/
https://www.ncbi.nlm.nih.gov/pubmed/35431486
http://dx.doi.org/10.4103/jets.jets_80_21
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author Zhang, Yuan Helen
De Silva, Muthuwadura Waruni Subashini
Allen, John Carson
Lateef, Fatimah
Omar, Eunizar Binte
author_facet Zhang, Yuan Helen
De Silva, Muthuwadura Waruni Subashini
Allen, John Carson
Lateef, Fatimah
Omar, Eunizar Binte
author_sort Zhang, Yuan Helen
collection PubMed
description INTRODUCTION: End-of-life (EOL) conditions are commonly encountered by emergency physicians (EP). We aim to explore EPs’ experience and perspectives toward EOL discussions in acute settings. METHODS: A qualitative survey was conducted among EPs in three tertiary institutions. Data on demographics, EOL knowledge, conflict management strategies, comfort level, and perceived barriers to EOL discussions were collected. Data analysis was performed using SPSS and SAS. RESULTS: Of 63 respondents, 40 (63.5%) were male. Respondents comprised 22 senior residents/registrars, 9 associate consultants, 22 consultants, and 10 senior consultants. The median duration of emergency department practice was 8 (interquartile range: 6–10) years. A majority (79.3%) reported conducting EOL discussions daily to weekly, with most (90.5%) able to obtain general agreement with families and patients regarding goals of care. Top barriers were communications with family/clinicians, lack of understanding of palliative care, and lack of rapport with patients. 38 (60.3%) deferred discussions to other colleagues (e.g., intensivists), 10 (15.9%) involved more family members, and 13 (20.6%) employed a combination of approaches. Physician's comfort level in discussing EOL issues also differed with physician seniority and patient type. There was a positive correlation between the mean general comfort level when discussing EOL and the seniority of the EPs up till consultancy. However, the comfort level dropped among senior consultants as compared to consultants. EPs were most comfortable discussing EOL of patients with a known terminal illness and least comfortable in cases of sudden death. CONCLUSIONS: Formal training and standardized framework would be useful to enhance the competency of EPs in conducting EOL discussions.
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spelling pubmed-90067162022-04-14 End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives Zhang, Yuan Helen De Silva, Muthuwadura Waruni Subashini Allen, John Carson Lateef, Fatimah Omar, Eunizar Binte J Emerg Trauma Shock Original Article INTRODUCTION: End-of-life (EOL) conditions are commonly encountered by emergency physicians (EP). We aim to explore EPs’ experience and perspectives toward EOL discussions in acute settings. METHODS: A qualitative survey was conducted among EPs in three tertiary institutions. Data on demographics, EOL knowledge, conflict management strategies, comfort level, and perceived barriers to EOL discussions were collected. Data analysis was performed using SPSS and SAS. RESULTS: Of 63 respondents, 40 (63.5%) were male. Respondents comprised 22 senior residents/registrars, 9 associate consultants, 22 consultants, and 10 senior consultants. The median duration of emergency department practice was 8 (interquartile range: 6–10) years. A majority (79.3%) reported conducting EOL discussions daily to weekly, with most (90.5%) able to obtain general agreement with families and patients regarding goals of care. Top barriers were communications with family/clinicians, lack of understanding of palliative care, and lack of rapport with patients. 38 (60.3%) deferred discussions to other colleagues (e.g., intensivists), 10 (15.9%) involved more family members, and 13 (20.6%) employed a combination of approaches. Physician's comfort level in discussing EOL issues also differed with physician seniority and patient type. There was a positive correlation between the mean general comfort level when discussing EOL and the seniority of the EPs up till consultancy. However, the comfort level dropped among senior consultants as compared to consultants. EPs were most comfortable discussing EOL of patients with a known terminal illness and least comfortable in cases of sudden death. CONCLUSIONS: Formal training and standardized framework would be useful to enhance the competency of EPs in conducting EOL discussions. Wolters Kluwer - Medknow 2022 2022-04-04 /pmc/articles/PMC9006716/ /pubmed/35431486 http://dx.doi.org/10.4103/jets.jets_80_21 Text en Copyright: © 2022 Journal of Emergencies, Trauma, and Shock https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Zhang, Yuan Helen
De Silva, Muthuwadura Waruni Subashini
Allen, John Carson
Lateef, Fatimah
Omar, Eunizar Binte
End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives
title End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives
title_full End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives
title_fullStr End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives
title_full_unstemmed End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives
title_short End-of-Life Communication in the Emergency Department: The Emergency Physicians’ Perspectives
title_sort end-of-life communication in the emergency department: the emergency physicians’ perspectives
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006716/
https://www.ncbi.nlm.nih.gov/pubmed/35431486
http://dx.doi.org/10.4103/jets.jets_80_21
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