Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 86-93.e1 , July 2009

Am I Doing the Right Thing? Provider Perspectives on Improving Palliative Care in the Emergency Department

  • Alexander K. Smith, MD, MS, MPH

      Affiliations

    • Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
    • Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
    • Dr. Smith is now with Division of Geriatrics, University of California, San Francisco, San Francisco, CA.
    • Corresponding Author InformationAddress for correspondence: Alexander K. Smith, MD, MS, MPH, Division Geriatrics, UCSF, 4150 Clement St (181G), San Francisco, CA 94121; 415-221-4810 extension 4684, fax: 415-750-6641
    • ,
  • Jonathan Fisher, MD

      Affiliations

    • Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
    • ,
  • Mara A. Schonberg, MD, MPH

      Affiliations

    • Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
    • ,
  • Daniel J. Pallin, MD, MPH

      Affiliations

    • Department of Emergency Medicine, Brigham and Women's Hospital, and Division of Emergency Medicine, Children's Hospital Boston, Boston, MA
    • ,
  • Susan D. Block, MD

      Affiliations

    • Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
    • ,
  • Lachlan Forrow, MD

      Affiliations

    • Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
    • ,
  • Russell S. Phillips, MD

      Affiliations

    • Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
    • ,
  • Ellen P. McCarthy, PhD, MPH

      Affiliations

    • Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA

Received 30 April 2008 ,Revised 11 August 2008 ,Accepted 22 August 2008.

References 

  1. Earle CC, Neville BA, Landrum MB, et al. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22:315–321
  2. Meier DE, Beresford L. Fast response is key to partnering with the emergency department. J Palliat Med. 2007;10:641–645
  3. EPEC-EM. http://www.epec.net/EPEC/Webpages/epecem.cfmAccessed April 14, 2008
  4. Chan GK. End-of-life and palliative care in the emergency department: a call for research, education, policy and improved practice in this frontier area. J Emerg Nurs. 2006;32:101–103
  5. Goodacre S. Research methods: beyond the clinical trial. Ann Emerg Med. 2003;42:56–65
  6. Maxwell JA. Qualitative Research Design: An Iterative Approach. Thousand Oaks, CA: Sage Publications; 1996;
  7. American Academy of Hospice and Palliative Medicine. http://www.aahpm.org/about/index.html#DefinitionAccessed April 15, 2007
  8. Rice PL, Ezzy D. Qualitative Research Methods: A Health Focus. New York, NY: Oxford University Press; 1999;
  9. A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report. Washington, DC: NQF; 2006;
  10. Morrison RS, Meier DE. Clinical practice (Palliative care). N Engl J Med. 2004;350:2582–2590
  11. Wilper AP, Woolhandler S, Lasser KE, et al. Waits to see an emergency department physician: US trends and predictors, 1997-2004. Health Aff (Millwood). 2008;27:w84–w95
  12. Covinsky KE, Goldman L, Cook EF, et al. The impact of serious illness on patients' families. SUPPORT Investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment). JAMA. 1994;272:1839–1844
  13. Emanuel EJ, Fairclough DL, Slutsman J, et al. Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med. 2000;132:451–459
  14. Glajchen M. The emerging role and needs of family caregivers in cancer care. J Support Oncol. 2004;2:145–155
  15. Teno JM, Hakim RB, Knaus WA, et al. Preferences for cardiopulmonary resuscitation: physician-patient agreement and hospital resource use (The SUPPORT Investigators). J Gen Intern Med. 1995;10:179–186
  16. Prendergast TJ. Advance care planning: pitfalls, progress, promise. Crit Care Med. 2001;29(2 suppl):N34–N39
  17. Fagerlin A, Schneider CE. Enough (The failure of the living will). Hastings Cent Rep. 2004;34:30–42
  18. Raschke RA, Gollihare B, Wunderlich TA, et al. A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital. JAMA. 1998;280:1317–1320
  19. Pletcher MJ, Kertesz SG, Kohn MA, et al. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299:70–78

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Rita K. Cydulka, MD, MS

 Author contributions: AKS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AKS, JF, MAS, DJP, SDB, LF, RSP, and EPM were responsible for study concept and design and revision of the article for important intellectual content. AKS acquired the data. AKS, JF, and MAS were responsible for analysis and interpretation of data. AKS drafted the article. LF obtained funding. AKS supervised the study. AKS takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was performed in its entirety while Dr. Smith was a general medicine fellow at Beth Israel Deaconess Medical Center. This research was supported by The Julie Henry Fund at Beth Israel Deaconess Hospital. Dr. Smith was supported by an institutional National Research Service Award, #5 T32 HP11001-19.

 Publication date: Available online October 18, 2008.

 Reprints not available from the authors.

PII: S0196-0644(08)01647-8

doi: 10.1016/j.annemergmed.2008.08.022

Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 86-93.e1 , July 2009

Article Tools