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 demographi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Emergencies, Trauma and Shock |
| Subjects: | |
| Online Access: | http://www.onlinejets.org/article.asp?issn=0974-2700;year=2022;volume=15;issue=1;spage=29;epage=34;aulast=Zhang |
| _version_ | 1817991098196295680 |
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| author | Yuan Helen Zhang Muthuwadura Waruni Subashini De Silva John Carson Allen Jr Fatimah Lateef Eunizar Binte Omar |
| author_facet | Yuan Helen Zhang Muthuwadura Waruni Subashini De Silva John Carson Allen Jr Fatimah Lateef Eunizar Binte Omar |
| author_sort | Yuan Helen Zhang |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-14T01:08:36Z |
| format | Article |
| id | doaj.art-e5c2d62b41894ffa91d46641542f6a44 |
| institution | Directory Open Access Journal |
| issn | 0974-2700 |
| language | English |
| last_indexed | 2024-04-14T01:08:36Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Emergencies, Trauma and Shock |
| spelling | doaj.art-e5c2d62b41894ffa91d46641542f6a442022-12-22T02:21:10ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27002022-01-01151293410.4103/jets.jets_80_21End-of-Life communication in the emergency department: The emergency physicians' perspectivesYuan Helen ZhangMuthuwadura Waruni Subashini De SilvaJohn Carson Allen JrFatimah LateefEunizar Binte OmarIntroduction: 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.http://www.onlinejets.org/article.asp?issn=0974-2700;year=2022;volume=15;issue=1;spage=29;epage=34;aulast=Zhangbarrierscommunicationemergency departmentemergency physiciansend-of-life discussion |
| spellingShingle | Yuan Helen Zhang Muthuwadura Waruni Subashini De Silva John Carson Allen Jr Fatimah Lateef Eunizar Binte Omar End-of-Life communication in the emergency department: The emergency physicians' perspectives Journal of Emergencies, Trauma and Shock barriers communication emergency department emergency physicians end-of-life discussion |
| 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 | barriers communication emergency department emergency physicians end-of-life discussion |
| url | http://www.onlinejets.org/article.asp?issn=0974-2700;year=2022;volume=15;issue=1;spage=29;epage=34;aulast=Zhang |
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