Physician Attitudes on the Provision of Palliative Care in Puerto Rican Emergency Departments

Background: A palliative approach is recommended in the care of Parkinson’s disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson’s disease patients. Aim: To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson’s disease patients and their reported referral practices. Design: A cross-sectional survey study of neurologists. Setting/participants: A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology’s clinician database. Results: Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = −16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral. Conclusion: Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

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P083: Developing an interview guide to explore physicians perceptions about unmet palliative care needs in Albertas emergency departments

CJEM ◽

10.1017/cem.2018.281 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S86-S86

Author(s):

M. Kruhlak ◽

C. Villa-Roel ◽

B. H. Rowe ◽

P. McLane

Keyword(s):

Palliative Care ◽

Emergency Departments ◽

Study Groups ◽

Severe Illness ◽

Care Needs ◽

Initial Interview ◽

Qualitative Researcher ◽

Interview Guide ◽

Pilot Work ◽

Qualitative Component

Introduction: Many patients with advanced or end-stage diseases spend months or years in need of optimal physical, spiritual, psychological, and social care. Despite efforts to provide community care, those with severe illness often present to emergency departments (EDs). This abstract presents preliminary results on the qualitative component of an ED-based mixed methods pilot study. The objective of this qualitative component is to develop and test an interview guide to collect qualitative data on physicians perceptions about unmet palliative care (PC) and end of life care (EOLC) needs in EDs. Methods: A scan of the literature on PC and EOLC in EDs was conducted to develop propositions about what might be expected through the clinician interviews, as well as an interview guide. The interview guide will be piloted with up to four ED physicians. During the interview each physician will describe a case where a PC patient had unmet care needs and the impacts they believe these unmet needs had on patients and families. Interview transcripts will be coded descriptively and then conceptually themed by the researcher who conducted the interview. Interpretations drawn from the interview data, with supporting quotations and comparison to initial propositions, will be presented to members of the research team with experience providing ED care, for further interpretation. Advice of a second trained qualitative researcher will be sought on the richness and relevance of data obtained and how the interview guide could be improved to elicit richer and/or more relevant data. A revised interview guide will be produced alongside rationales for why the proposed revisions will elicit richer data. Results: After reviewing 27 articles on PC and EOLC, propositions and an initial interview guide were developed based on themes from the literature and the study groups experiences. One of the primary results of this pilot work will be an enhanced understanding of PC and EOLC in our local ED context, as reflected in an interview guide revised to elicit richer data than achieved through the initial interview guide. Conclusion: The comparison between our propositions and the study findings will help identify how biases may have influenced interview questions and/or the interpretation of the data. This pilot work to develop an interview guide enhances the rigour of this qualitative work on unmet PC and EOLC needs in EDs.

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(Early) Palliative Care in Rettungsdienst und Notaufnahme

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/s-0043-115631 ◽

2018 ◽

Vol 143 (08) ◽

pp. 551-557

Author(s):

Maximilian Spickermann ◽

Philipp Lenz

Keyword(s):

Palliative Care ◽

General Practitioner ◽

Hospital Stay ◽

End Of Life ◽

Emergency Departments ◽

Screening Tool ◽

Emergency Services ◽

Outpatient Setting ◽

Early Palliative Care ◽

Prehospital Emergency

AbstractAt the end of life patients with a life-limiting disease are often admitted to emergency departments (ED). Mostly, in the setting of an ED there may not be enough time to meet the needs for palliative care (PC) of these patients. Therefore, integration of PC into the ED offers a solution to improve their treatment. In the outpatient setting a cooperation between prehospital emergency services, the patient’s general practitioner and specialized outpatient PC teams may allow the patient to die at home – this is what most patients prefer at the end of life. Furthermore, due to the earlier integration of PC after admission the hospital stay is shortened. Also the number of PC consultations may increase. Additionally, a screening of PC hneeds among all patients visiting the ED may be beneficial: to avoid not meeting existing PC needs and to standardize the need of PC consultation. An example for such a screening tool is the “Palliative Care and Rapid Emergency Screening” (P-CaRES).

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Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118823182 ◽

2019 ◽

Vol 36 (8) ◽

pp. 669-674 ◽

Cited By ~ 2

Author(s):

Holly B. Cunningham ◽

Shannon A. Scielzo ◽

Paul A. Nakonezny ◽

Brandon R. Bruns ◽

Karen J. Brasel ◽

...

Keyword(s):

Palliative Care ◽

Geriatric Patients ◽

Care Physician ◽

Physician Attitudes ◽

The Other ◽

Goals Of Care ◽

Care Community ◽

Trauma Surgeons ◽

Better Than ◽

Do So

Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.

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