Mapping the future for research in emergency medicine palliative care: A research roadmap.
Journal
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
ISSN: 1553-2712
Titre abrégé: Acad Emerg Med
Pays: United States
ID NLM: 9418450
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
10
03
2022
received:
02
12
2021
accepted:
23
03
2022
pubmed:
4
4
2022
medline:
13
8
2022
entrez:
3
4
2022
Statut:
ppublish
Résumé
The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics. Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.
Sections du résumé
BACKGROUND
The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation.
OBJECTIVE
The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research.
METHODS
Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics.
RESULTS
Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC.
CONCLUSIONS
There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
963-973Informations de copyright
© 2022 Society for Academic Emergency Medicine.
Références
Medicare spending at the end of life: a snapshot of beneficiaries who died in 2014 and the cost of their care. Kaiser Family Foundation. 2016. Accessed February 20, 2021. https://www.kff.org/medicare/issue-brief/medicare-spending-at-the-end-of-life/
Duncan I, Ahmed T, Dove H, Maxwell TL. Medicare cost at end of life. Am J Hosp Palliat Care. 2019;36(8):705-710.
Smith AK, McCarthy E, Weber E, et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012;31(6):1277-1285.
Teno JM, Gozalo PL, Bynum JP, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470-477.
Wu FM, Newman JM, Lasher A, Brody AA. Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. J Palliat Med. 2013;16(11):1362-1367.
Grudzen CR, Richardson LD, Johnson PN, et al. Emergency department-initiated palliative care in advanced cancer: a randomized clinical trial. JAMA Oncol. 2016;2(5):591-598.
Wang DH, Heidt R. Emergency department admission triggers for palliative consultation may decrease length of stay and costs. J Palliat Med. 2021;24(4):554-560.
Carpenter CR, Bromley M, Caterino JM, et al. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine. J Am Geriatr Soc. 2014;62(7):1360-1363.
ACEP - Delaying Palliative Care and Hospice Care Services in the Emergency Department. 2013. Accessed July 28, 2020. https://www.choosingwisely.org/clinician-lists/american-college-emergency-physicians-delaying-palliative-and-hospice-care-services-in-emergency-department/
Quest TE, Asplin BR, Cairns CB, Hwang U, Pines JM. Research priorities for palliative and end-of-life care in the emergency setting. Acad Emerg Med. 2011;18(6):e70-e76.
Estimates of funding for various research, condition, and disease categories (RCDC). NIH RePORT: Research Portfolio Online Reporting Tools. NIH (National Institute of Health); 2021. Accessed August 9, 2021. https://report.nih.gov/funding/categorical-spending#/
Lee J, Abrukin L, Flores S, et al. Early intervention of palliative care in the emergency department during the COVID-19 pandemic. JAMA Intern Med. 2020;180(9):1252-1254.
Stoltenberg M, Jacobsen J, Wilson E, et al. Emergency department-based palliative care during COVID. J Palliat Med. 2020;23(9):1151-1152.
Lai L, Sato R, He S, et al. Usage patterns of a web-based palliative care content platform (PalliCOVID) during the COVID-19 pandemic. J Pain Symptom Manage. 2020;60(4):e20-e27.
Aaronson EL, Daubman BR, Petrillo L, et al. Emerging palliative care innovations in the ED: a qualitative analysis of programmatic elements during the COVID-19 pandemic. J Pain Symptom Manage. 2021;62(1):117-124.
George NR, Kryworuchko J, Hunold KM, et al. Shared decision making to support the provision of palliative and end-of-life care in the emergency department: a consensus statement and research agenda. Acad Emerg Med. 2016;23(12):1394-1402.
Carpenter CR, Heard K, Wilber S, et al. Research priorities for high-quality geriatric emergency care: medication management, screening, and prevention and functional assessment. Acad Emerg Med. 2011;18(6):644-654.
Brown J, Grudzen C, Kyriacou DN, et al. The emergency care of patients with cancer: setting the research agenda. Ann Emerg Med. 2016;68(6):706-711.
Wilson JG, English DP, Owyang CG, et al. End-of-life care, palliative care consultation, and palliative care referral in the emergency department: a systematic review. J Pain Symptom Manage. 2020;59(2):372-383.e1.
da Silva SD, Nunes CM, Gomes B. Effectiveness of emergency department based palliative care for adults with advanced disease: a systematic review. J Palliat Med. 2016;19(6):601-609.
Cooper E, Hutchinson A, Sheikh Z, Taylor P, Townend W, Johnson MJ. Palliative care in the emergency department: a systematic literature qualitative review and thematic synthesis. Palliat Med. 2018;32(9):1443-1454.
George N, Phillips E, Zaurova M, Song C, Lamba S, Grudzen C. Palliative care screening and assessment in the emergency department: a systematic review. J Pain Symptom Manage. 2016;51(1):108-119.e2.
Kirkland SW, Ghalab A, Kruhlak M, et al. An assessment of emergency department-based interventions for patients with advanced or end-stage illness: a systematic review. J Palliat Med. 2021;24(4):605-618.
Wong J, Gott M, Frey R, Jull A. What is the incidence of patients with palliative care needs presenting to the emergency department? a critical review. Palliat Med. 2014;28(10):1197-1205.
Lawrenson R, Waetford J, Gibbons V, Kirk P, Haggar S, Reddy R. Palliative care patients' use of emergency departments. N Z Med J. 2013;126(1372):80-88.
Wallace EM, Cooney MC, Walsh J, Conroy M, Twomey F. Why do palliative care patients present to the emergency department? Avoidable or unavoidable? Am J Hosp Palliat Care. 2013;30(3):253-256.
Oulton J, Rhodes SM, Howe C, Fain MJ, Mohler MJ. Advance directives for older adults in the emergency department: a systematic review. J Palliat Med. 2015;18(6):500-505.
Rosenwax LK, McNamara BA, Murray K, McCabe RJ, Aoun SM, Currow DC. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust. 2011;194(11):570-573.
Lee YH, Chu D, Yang NP, et al. Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study. BMC Palliat Care. 2015;14:25.
Ouchi K, Wu M, Medairos R, et al. Initiating palliative care consults for advanced dementia patients in the emergency department. J Palliat Med. 2014;17(3):346-350.
Grudzen CR, Richardson LD, Morrison M, Cho E, Morrison RS. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253-1257.
Beynon T, Gomes B, Murtagh FE, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;28(6):491-495.
Mayer DK, Travers D, Wyss A, Leak A, Waller A. Why do patients with cancer visit emergency departments? Results of a 2008 population study in North Carolina. J Clin Oncol. 2011;29(19):2683-2688.
Leak A, Mayer DK, Wyss A, Travers D, Waller A. Why do cancer patients die in the emergency department?: an analysis of 283 deaths in NC EDs. Am J Hosp Palliat Care. 2013;30(2):178-182.
Grudzen CR, Hwang U, Cohen JA, Fischman M, Morrison RS. Characteristics of emergency department patients who receive a palliative care consultation. J Palliat Med. 2012;15(4):396-399.
Green E, Ward S, Brierley W, Riley B, Sattar H, Harris T. “They shouldn't be coming to the ED, should they?”: a descriptive service evaluation of why patients with palliative care needs present to the emergency department. Am J Hosp Palliat Care. 2017;34(10):984-990.
Green E, Shaw SE, Harris T. “They shouldn't be coming to the ED, should they?” A qualitative study of why patients with palliative care needs present to the emergency department. BMJ Support Palliat Care. 2019;9(4):e29.
Köstenberger M, Neuwersch S, Weixler D, Pipam W, Zink M, Likar R. Prevalence of palliative care patients in emergency departments. Wien Klin Wochenschr. 2019;131(17-18):404-409.
Verhoef MJ, de Nijs E, Horeweg N, et al. Palliative care needs of advanced cancer patients in the emergency department at the end of life: an observational cohort study. Support Care Cancer. 2020;28(3):1097-1107.
Argintaru N, Quinn KL, Chartier LB, et al. Perceived barriers and facilitators to goals of care discussions in the emergency department: a descriptive analysis of the views of emergency medicine physicians and residents. CJEM. 2019;21(2):211-218.
Goepp JG, Meykler S, Mooney NE, Lyon C, Raso R, Julliard K. Provider insights about palliative care barriers and facilitators: results of a rapid ethnographic assessment. Am J Hosp Palliat Care. 2008;25(4):309-314.
Lamba S, Nagurka R, Zielinski A, Scott SR. Palliative care provision in the emergency department: barriers reported by emergency physicians. J Palliat Med. 2013;16(2):143-147.
Grudzen CR, Richardson LD, Major-Monfried H, Kandarian B, Ortiz JM, Morrison RS. Hospital administrators' views on barriers and opportunities to delivering palliative care in the emergency department. Ann Emerg Med. 2013;61(6):654-660.
Stone SC, Mohanty S, Grudzen CR, et al. Emergency medicine physicians' perspectives of providing palliative care in an emergency department. J Palliat Med. 2011;14(12):1333-1338.
McCallum KJ, Jackson D, Walthall H, Aveyard H. Exploring the quality of the dying and death experience in the emergency department: an integrative literature review. Int J Nurs Stud. 2018;85:106-117.
Kongsuwan W, Matchim Y, Nilmanat K, Locsin RC, Tanioka T, Yasuhara Y. Lived experience of caring for dying patients in emergency room. Int Nurs Rev. 2016;63(1):132-138.
Smith AK, Fisher J, Schonberg MA, et al. Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009;54(1):86-93.e1.
Aaronson EL, Petrillo L, Stoltenberg M, et al. The experience of emergency department providers with embedded palliative care during COVID. J Pain Symptom Manage. 2020;60(5):e35-e43.
Haydar SA, Almeder L, Michalakes L, Han PK, Strout TD. Using the surprise question to identify those with unmet palliative care needs in emergency and inpatient settings: what do clinicians think? J Palliat Med. 2017;20(7):729-735.
Wright RJ, Lowton K, Robert G, Grudzen CR, Grocott P. Emergency department staff priorities for improving palliative care provision for older people: a qualitative study. Palliat Med. 2018;32(2):417-425.
Di Leo S, Alquati S, Autelitano C, et al. Palliative care in the emergency department as seen by providers and users: a qualitative study. Scand J Trauma Resusc Emerg Med. 2019;27(1):88.
Marck CH, Weil J, Lane H, et al. Care of the dying cancer patient in the emergency department: findings from a national survey of Australian emergency department clinicians. Intern Med J. 2014;44(4):362-368.
Rosenberg M, Lamba S, Misra S. Palliative medicine and geriatric emergency care: challenges, opportunities, and basic principles. Clin Geriatr Med. 2013;29(1):1-29.
Kompanje EJ. The worst is yet to come. Many elderly patients with chronic terminal illnesses will eventually die in the emergency department. Intensive Care Med. 2010;36(5):732-734.
Ouchi K, George N, Schuur JD, et al. Goals-of-care conversations for older adults with serious illness in the emergency department: challenges and opportunities. Ann Emerg Med. 2019;74(2):276-284.
George N, Bowman J, Aaronson E, Ouchi K. Past, present, and future of palliative care in emergency medicine in the USA. Acute Med Surg. 2020;7(1):e497.
McNamara R. Emergency palliative care. Emerg Med J. 2020;37(5):260-261.
Wang DH. Beyond code status: palliative care begins in the emergency department. Ann Emerg Med. 2017;69(4):437-443.
Hughes J. Palliative care in emergency medicine: a perennial skill with a new emphasis. CJEM. 2019;21(2):163-164.
Lamba S, Quest TE. Hospice care and the emergency department: rules, regulations, and referrals. Ann Emerg Med. 2011;57(3):282-290.
Grudzen CR, Stone SC, Morrison RS. The palliative care model for emergency department patients with advanced illness. J Palliat Med. 2011;14(8):945-950.
Lamba S, Mosenthal AC. Hospice and palliative medicine: a novel subspecialty of emergency medicine. J Emerg Med. 2012;43(5):849-853.
Shoenberger J, Lamba S, Goett R, et al. Development of hospice and palliative medicine knowledge and skills for emergency medicine residents: using the Accreditation Council for Graduate Medical Education Milestone Framework. AEM Educ Train. 2018;2(2):130-145.
Blackwell RW, Lowton K, Robert G, Grudzen C, Grocott P. Using experience-based co-design with older patients, their families and staff to improve palliative care experiences in the emergency department: a reflective critique on the process and outcomes. Int J Nurs Stud. 2017;68:83-94.
Kistler EA, Sean Morrison R, Richardson LD, Ortiz JM, Grudzen CR. Emergency department-triggered palliative care in advanced cancer: proof of concept. Acad Emerg Med. 2015;22(2):237-239.
Mahony SO, Blank A, Simpson J, et al. Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients. J Urban Health. 2008;85(3):443-451.
Ting SM, Li P, Lau FL, et al. Acute bereavement care in the emergency department: does the professional-supported volunteers model work? Eur J Emerg Med. 1999;6(3):237-243.
Rosenberg M, Rosenberg L. Integrated model of palliative care in the emergency department. West J Emerg Med. 2013;14(6):633-636.
Carron PN, Dami F, Diawara F, Hurst S, Hugli O. Palliative care and prehospital emergency medicine: analysis of a case series. Medicine (Baltimore). 2014;93(25):e128.
Weng TC, Yang YC, Chen PJ, et al. Implementing a novel model for hospice and palliative care in the emergency department: an experience from a tertiary medical center in Taiwan. Medicine (Baltimore). 2017;96(19):e6943.
Gisondi MA, Lu DW, Yen M, et al. Adaptation of EPEC-EM curriculum in a residency with asynchronous learning. West J Emerg Med. 2010;11(5):491-499.
Lamba S, DeSandre PL, Todd KH, et al. Integration of palliative care into emergency medicine: the Improving Palliative Care in Emergency Medicine (IPAL-EM) collaboration. J Emerg Med. 2014;46(2):264-270.
Shoenberger JM, Yeghiazarian S, Rios C, Henderson SO. Death notification in the emergency department: survivors and physicians. West J Emerg Med. 2013;14(2):181-185.
Lamba S, Pound A, Rella JG, Compton S. Emergency medicine resident education in palliative care: a needs assessment. J Palliat Med. 2012;15(5):516-520.
Goldonowicz JM, Runyon MS, Bullard MJ. Palliative care in the emergency department: an educational investigation and intervention. BMC Palliat Care. 2018;17(1):43.
Glajchen M, Lawson R, Homel P, Desandre P, Todd KH. A rapid two-stage screening protocol for palliative care in the emergency department: a quality improvement initiative. J Pain Symptom Manage. 2011;42(5):657-662.
Leiter RE, Yusufov M, Hasdianda MA, et al. Fidelity and feasibility of a brief emergency department intervention to empower adults with serious illness to initiate advance care planning conversations. J Pain Symptom Manage. 2018;56(6):878-885.
Ouchi K, Knabben V, Rivera-Reyes L, et al. Preparing older adults with serious illness to formulate their goals for medical care in the emergency department. J Palliat Med. 2017;20(4):404-408.
Ouchi K, Block SD, Schonberg MA, et al. Feasibility testing of an emergency department screening tool to identify older adults appropriate for palliative care consultation. J Palliat Med. 2017;20(1):69-73.
George N, Barrett N, McPeake L, Goett R, Anderson K, Baird J. Content validation of a novel screening tool to identify emergency department patients with significant palliative care needs. Acad Emerg Med. 2015;22(7):823-837.
Kistler EA, Stevens E, Scott E, Philpotts LL, Greer JA, Greenwald JL. Triggered palliative care consults: a systematic review of interventions for hospitalized and emergency department patients. J Pain Symptom Manage. 2020;60(2):460-475.
Smith AK, Schonberg MA, Fisher J, et al. Emergency department experiences of acutely symptomatic patients with terminal illness and their family caregivers. J Pain Symptom Manage. 2010;39(6):972-981.
Parris RJ, Schlosenberg J, Stanley C, Maurice S, Clarke SF. Emergency department follow-up of bereaved relatives: an audit of one particular service. Emerg Med J. 2007;24(5):339-342.
Wright R, Lowton K, Hansen BR, Grocott P. Older adult and family caregiver preferences for emergency department based-palliative care: an experience-based co-design study. Int J Nurs Sties Advances. 2021;3:100016.
Wright R, Hayward B, Kistler E, Vaughan Dickson V, Grudzen C. That was a game changer: clinical impact of an emergency department-based palliative care communication skills training workshop. Emerg Med J. 2020;37(5):262-264.
Lamba S, DeSandre PL, Quest TE. Opportunities and challenges facing the integrated physician workforce of emergency medicine and hospice and palliative medicine. J Emerg Med. 2016;51(6):658-667.
Fusi-Schmidhauser T, Preston NJ, Keller N, Gamondi C. Conservative management of COVID-19 patients--emergency palliative care in action. J Pain Symptom Manage. 2020;60(1):e27-e30.
Chidiac C, Feuer D, Naismith J, Flatley M, Preston N. Emergency palliative care planning and support in a COVID-19 pandemic. J Palliat Med. 2020;23(6):752-753.
Jünger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med. 2017;31(8):684-706.
Currow DC, Wheeler JL, Glare PA, Kaasa S, Abernethy AP. A framework for generalizability in palliative care. J Pain Symptom Manage. 2009;37(3):373-386.
Currow DC, Tieman JJ, Greene A, Zafar SY, Wheeler JL, Abernethy AP. Refining a checklist for reporting patient populations and service characteristics in hospice and palliative care research. J Pain Symptom Manage. 2012;43(5):902-910.
Hagen NA, Wu JS, Stiles CR. A proposed taxonomy of terms to guide the clinical trial recruitment process. J Pain Symptom Manage. 2010;40(1):102-110.
Higginson IJ, Evans CJ, Grande G, et al. Evaluating complex interventions in end of life care: the MORECare statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. BMC Med. 2013;11:111.
Neta G, Glasgow RE, Carpenter CR, et al. A framework for enhancing the value of research for dissemination and implementation. Am J Public Health. 2015;105(1):49-57.
Borgstrom E, Barclay S. Experience-based design, co-design and experience-based co-design in palliative and end-of-life care. BMJ Support Palliat Care. 2019;9(1):60-66.
Brown Speights JS, Nowakowski AC, De Leon J, Mitchell MM, Simpson I. Engaging African American women in research: an approach to eliminate health disparities in the African American community. Fam Pract. 2017;34(3):322-329.
Brockie T, Azar K, Wallen G, O'Hanlon Solis M, Adams K, Kub J. A conceptual model for establishing collaborative partnerships between universities and Native American communities. Nurse Res. 2019;27(1):27-32.