Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 94-102 , July 2009

Hospice and Palliative Medicine: New Subspecialty, New Opportunities

  • Tammie E. Quest, MD

      Affiliations

    • Emory University, Atlanta, GA
    • Corresponding Author InformationAddress for correspondence: Tammie E. Quest, MD, Emory University, Atlanta, GA 30303; 404-616-2231, fax 404-616-6182
  • ,
  • Catherine A. Marco, MD

      Affiliations

    • University of Toledo, Toledo, OH
  • ,
  • Arthur R. Derse, MD, JD

      Affiliations

    • Department of Population Health-Bioethics and Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI

Received 30 October 2007 ,Revised 17 November 2008 ,Accepted 25 November 2008.

References 

  1. von Gunten CF, Lupu D. Development of a medical subspecialty in palliative medicine: progress report. J Palliat Med. 2004;7:209–219
  2. American Board of Medical Subspecialties, Research and Education Foundation. 2002 Annual Report and Reference Handbook. In: 2002;p. 75;Evanston, IL:.
  3. Morrison RS, Meier DE. Clinical practice: palliative care. N Engl J Med. 2004;350:2582–2590
  4. http://www.aahpm.org/positions/definition.htmlAccessed June 18, 2007.
  5. Schears RM. Emergency physicians' role in end-of-life care. Emerg Med Clin North Am. 1999;17:539–559xiv.
  6. Chan GK. End-of-life models and emergency department care. Acad Emerg Med. 2004;11:79–86
  7. Ausband SC, March JA, Brown LH. National prevalence of palliative care protocols in emergency medical services. Prehosp Emerg Care. 2002;6:36–41
  8. 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
  9. von Gunten CF. Secondary and tertiary palliative care in US hospitals. JAMA. 2002;287:875–881
  10. Center to Advance Palliative Care. http://www.capc.org
  11. Meier DE, Beresford L. Fast response is key to partnering with the emergency department. J Palliat Med. 2007;10:641–645
  12. 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;85:443–451
  13. National Consensus Project for Quality Palliative Care. http://www.nationalconsensusproject.orgAccessed July 25, 2008.
  14. Lunney JR, Lynn J, Hogan C. Profiles of older Medicare decedents. J Am Geriatr Soc. 2002;50:1108–1112
  15. Christakis NA. Prognostication and bioethics. Daedalus. 1999;128:197–214
  16. Christakis NA, Iwashyna TJ. Attitude and self-reported practice regarding prognostication in a national sample of internists. Arch Intern Med. 1998;158:2389–2395
  17. Lau F, Downing GM, Lesperance M, et al. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med. 2006;9:1066–1075
  18. Mozaffarian D, Anker SD, Anand I, et al. Prediction of mode of death in heart failure: the Seattle Heart Failure model. Circulation. 2007;116:392–398
  19. Matzo ML. Palliative care: prognostication and the chronically ill: methods you need to know as chronic disease progresses in older adults. Am J Nurs. 2004;104:40–49
  20. Mitchell SL, Kiely DK, Hamel MB, et al. Estimating prognosis for nursing home residents with advanced dementia. JAMA. 2004;291:2734–2740
  21. Reisfield GM, Wilson GR. Prognostication in heart failure #143. J Palliat Med. 2007;10:245–246
  22. Ewer MS, Kish SK, Martin CG, et al. Characteristics of cardiac arrest in cancer patients as a predictor of survival after cardiopulmonary resuscitation. Cancer. 2001;92:1905–1912
  23. Varon J, Walsh GL, Marik PE, et al. Should a cancer patient be resuscitated following an in-hospital cardiac arrest?. Resuscitation. 1998;36:165–168
  24. Bloom HL, Shukrullah I, Cuellar JR, et al. Long-term survival after successful inhospital cardiac arrest resuscitation. Am Heart J. 2007;153:831–836
  25. Weissman DE. Determining prognosis in advanced cancer #13. J Palliat Med. 2003;6:433–434
  26. Childers JW, Arnold RM, Curtis JR. Prognosis in end-stage chronic obstructive pulmonary disease #141. J Palliat Med. 2007;10:806–807
  27. Reisfield GM, Wilson GR. Prognostication in heart failure #143. J Palliat Med. 2007;10:245–246
  28. Kamath PS, Kim WR Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD). Hepatology. 2007;45:797–805
  29. Tsai S, Arnold RM. Prognostication in dementia #150. J Palliat Med. 2007;10:807–808
  30. ART Cohort Collaboration. Prognosis of HIV-1 infected patients up to five years after initiation of HAART: collaborative analysis of prospective studies. AIDS. 2007;21:1185–1197
  31. Wilner LS, Arnold RM. The Palliative Prognostic Score #62. J Palliat Med. 2006;9:993
  32. Fallowfield LF, Jenkins VA, Beveridge HA. Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med. 2002;16:297–303
  33. Hamel MB, Lynn J, Teno JM, et al. Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. J Am Geriatr Soc. 2000;48:S176–S182
  34. Marco CA, Schears RM. Societal preferences regarding cardiopulmonary resuscitation. Am J Emerg Med. 2002;20:207–211
  35. Taylor DM, Ugoni AM, Cameron PA, et al. Advance directives and emergency department patients: owners rates and perceptions of use. Intern Med J. 2003;33:586–592
  36. Llovera I, Mandel FS, Ryan JG, et al. Are emergency department patients thinking about advance directives?. Acad Emerg Med. 1997;4:976–980
  37. Llovera I, Ward MF, Ryan JG, et al. Why don't emergency department patients have advance directives?. Acad Emerg Med. 1999;6:1054–1060
  38. Ishihara KK, Wrenn K, Wright SW, et al. Advance directives in the emergency department: too few, too late. Acad Emerg Med. 1996;3:50–53
  39. Tulsky JA. Beyond advance directives: importance of communication skills at the end of life. JAMA. 2005;294:359–365
  40. Ditto PH, Jacobson JA, Smucker WD, et al. Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences. Med Decis Making. 2006;26:313–322
  41. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998;352:614–617
  42. Clark AP, Aldridge MD, Guzzetta CE, et al. Family presence during cardiopulmonary resuscitation. Crit Care Nurs Clin North Am. 2005;17:23–32
  43. Emergency Nurses Association. Position statement (Family presence at the bedside during invasive procedures and cardiopulmonary resuscitation). http://www.ena.org/about/position/PDFs/5F118F5052C2479C848012F5BCF87F7C.PDFAccessed May 14, 2008.
  44. Boie ET, Moore GP, Brummet C, et al. Do parents want to be present during invasive procedures performed on their children in the emergency department?. Ann Emerg Med. 1999;34:70–74
  45. Belanger MA, Reed S. A rural community hospital's experience with family-witnessed resuscitation. J Emerg Nurs. 1997;23:238–239
  46. Meyers TA, Eichhorn DJ, Guzzetta CE, et al. Family presence during invasive procedures and resuscitation. Am J Nurs. 2000;100:32–42
  47. Axelsson AB, Zettergren M, Axelsson C. Good and bad experiences of family presence during acute care and resuscitation (What makes the difference?). Eur J Cardiovasc Nurs. 2005;4:161–169
  48. Tschann JM, Kaufman SR, Micco GP. Family involvement in end-of-life hospital care. J Am Geriatr Soc. 2003;51:835–840
  49. Doyle CJ, Post H, Burney RE, et al. Family participation during resuscitation: an option. Ann Emerg Med. 1987;6:107–109
  50. Halm MA. Family presence during resuscitation: a critical review of the literature. Am J Crit Care. 2005;14:494–511
  51. Eichhorn DJ, Meyers Ta, Mitchell TG, et al. Opening the doors: family presence during resuscitation. J Cardiovasc Nurs. 1996;10:59–70
  52. Helmer SD, Smith RS, Dort JM, et al. Family presence during trauma resuscitation: a survey of AAST and ENA members. American Association for the Surgery of Trauma. Emergency Nurses Association. J Trauma. 2000;48:1015–1022
  53. McClenathan BM, Torrington KG, Uyehara CF. Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest. 2002;122:2204–2211
  54. Bradford KK, Kost S, Selbst SM, et al. Family member presence for procedures: the resident's perspective. Ambul Pediatr. 2005;5:294–297
  55. Macy C, Lampe E, O-Neil B, et al. The relationship between the hospital setting and perceptions of family-witnessed resuscitation in the emergency department. Resuscitation. 2006;70:74–79
  56. Sachetti AD, Paston C, Carraccio C. Do family members disrupt care when present during invasive procedures in children?. Acad Emerg Med. 2004;11:594–595
  57. Mangurten J, Scott SH, Guzzetta CE, et al. Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department. J Emerg Nurs. 2006;32:225–233
  58. Boyd R. Witnessed resuscitation by relatives. Resuscitation. 2000;43:171–176
  59. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet. 1998;352:614–617
  60. Hoffman DE, Tarzian AJ. Achieving the right balance in oversight of physician prescribing for pain: the role of state medical boards. J Law Med Ethics. 2003;31:21–40
  61. Ziegler SJ, Lovrich NP. Pain relief, prescription drugs, and prosecution: a four-state survey of chief prosecutors. J Law Med Ethics. 2003;31:75–100
  62. Dispensing of controlled substances for the treatment of pain. Fed Reg. 2004;69:67170–67171
  63. A controlled trial to improve care for seriously ill hospitalized patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274:1591–1598
  64. Weissman DE. Doctors, opioids, and the law: the effect of controlled substances regulations on cancer pain management. Semin Oncol. 1993;20:5308
  65. von Gunten C, Weissman DE. Ventilator withdrawal protocol. J Palliat Med. 2003;6:773–774
  66. Suter PM, Rogers J, Strack C. Artificial nutrition and hydration for the terminally ill: a reasoned approach. Home Healthc Nurse. 2008;26:23–29
  67. Kothare SV, Altman AM, Rodriguez IN. Position statement on laws and regulations concerning life-sustaining treatment, including artificial nutrition and hydration, for patients lacking decision-making capacity. Neurology. 2008;70:242;author reply 242-243.
  68. Ganzini L. Artificial nutrition and hydration at the end of life: ethics and evidence. Palliat Support Care. 2006;4:135–143
  69. Ferris FD. Last hours of living. Clin Geriatr Med. 2004;20:641–667
  70. Cassel JB, Lyckholm LJ. Identifying palliative care needs in the emergency department: better care, lower cost. Acad Emerg Med. 2006;13:S96
  71. Gazelle G. Understanding hospice—an underutilized option for life's final chapter. N Engl J Med. 2007;357:321–324
  72. Reeves K. Hospice care in the emergency department: important things to remember. J Emerg Nurs. 2000;26:477–478
  73. 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;85:443–451
  74. Cruzan v. Director of Missouri Department of Health, 497 U.S. 261, 110 S.Ct. 2841, 111 L.Ed.2d 224 (1990).
  75. In re Quinlan, 70 N.J. 10, 355 A.2d 647, cert. denied 429 U.S. 922, 97 S.Ct. 319, 50 L.Ed. 2d 289 (1976).
  76. Bartling v. Superior Court, 163 Cal.App.3d 186, 209 Cal. Rptr. 220 (1984).
  77. Bouvia v. Superior Court, 179 Cal.App3d 1127, 225 Cal. Rptr. 297 (1986).
  78. Wons v. Public Health Trust of Dade County, 500 So.2d 679 (Fla.App. 3 Dist. 1987).
  79. Annas GJ. The health care proxy and the living will. N Engl J Med. 1991;263:2365–2367
  80. Council on Ethical and Judicial Affairs. Medical Futility in End-of-Life Care. Opinion 2.037. Code of Medical Ethics: Current Opinions with Annotations. Chicago, IL: American Medical Association; 2004-2005;
  81. Sulmasy DP, Pellegrino ED. The rule of double effect: clearing up the double talk. Arch Intern Med. 1999;159:545–550
  82. Alpers A. Criminal act or palliative care? (prosecutions involving the care of the dying). J Law Med Ethics. 1998;26:308–331
  83. Tong E, McGraw SA, Dobihal E, et al. What is a good death? (minority and non-minority perspectives). J Palliat Care. 2003;19:168–175
  84. Kagawa-Singer M, Blackhall LJ. Negotiating cross-cultural issues at the end of life. JAMA. 2001;286:2993–3001
  85. Block SD. Psychological considerations, growth, and transcendence at the end of life. JAMA. 2001;285:2898–2905
  86. Hallenbeck J, Goldstein K, Mebane EW. Cultural considerations of death and dying in the United States. Clin Geriatr Med. 1996;12:393–406
  87. Rhymes JA. Barriers to effective palliative care of terminal patients. Clin Geriatr Med. 1996;12:407
  88. Ahrens WR, Hart RG. Emergency physicians' experience with pediatric death. Am J Emerg Med. 1997;15:642–643
  89. American Academic of PediatricsAmerican College of Emergency Physicians. Death of a child in the emergency department: joint statement by the American Academic of Pediatrics and the American College of Emergency Physicians. Pediatrics. 2002;110:839–840
  90. O'Malley P, Brown K, Mace SE American Academic of Pediatrics Committee on Pediatric Emergency Medicine American College of Emergency Physicians Pediatric Emergency Medicine Committee. Patient- and family-centered care and the role of the emergency physician providing care to a child in the emergency department. Ann Emerg Med. 2006;48:643–645
  91. Knazik SR, Gausche-Hill M, Dietrich AM, et al. The death of a child in the emergency department. Ann Emerg Med. 2003;42:519–529
  92. Ahrens W, Hart R, Maruyama N. Pediatric death: managing the aftermath in the emergency department. J Emerg Med. 1997;15:601–603
  93. Johnson L, Mattson S. Communication: the key to crisis prevention in pediatric death. Crit Care Nurs. 1992;12:23–27
  94. Korth SK. Unexpected pediatric death in the emergency department: supporting the family. J Emerg Nurs. 1988;14:302–306
  95. Foley T. Encouraging the inclusion of children in grief after a sudden death: memory bags. J Emerg Nurs. 2004;30:341–342
  96. Hart RG. Coping with pediatric death in the ED by learning from parental experience. Am J Emerg Med. 1998;16:67–68
  97. Greenberg LW, Ochsenslager D, Cohen GJ, et al. Counseling parents of a child dead on arrival: a survey of emergency departments. Am J Emerg Med. 1993;11:225–229
  98. Henretta CB, VanBrunt PF. Sudden pediatric death: meeting the needs of family and staff. Nurs Educ. 1982;7:13–16
  99. Bauchner H, Waring C, Vinci R. Parental presence during procedures in an emergency room: results from 50 observations. Pediatrics. 1991;87:544–548
  100. Powers KS, Rubenstein JS. Family presence during invasive procedures, I: the pediatric intensive care unit: a prospective study. Arch Pediatr Adolesc Med. 1999;153:955–958
  101. Henderson DP, Knapp JF. Report of the National Consensus Conference on Family Presence During Pediatric Cardiopulmonary Resuscitation and Procedures. Pediatr Emerg Care. 2005;21:787–791
  102. In:  Emanuel LL,  Quest TE editor. The Education in Palliative and End of Life Care Project—Emergency Medicine Trainer's Guide. 2008;
  103. 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. 2008;In press.
  104. Accreditation Council of Graduate Medical Education. Hospice and palliative medicine core competencies (Version 2.1). January 5, http://www.acgme.org/outcome/implement/HPM_Competencies_Ver_2_1.pdf2007;Accessed July 25, 2008.
  105. American Board of Hospice and Palliative Medicine. http://www.abhpm.orgAccessed January 18, 2009.
  106. American Board of Emergency Medicine. http://www.abem.org/public/portal/alias_Rainbow/lang_en-US/tabID_3799/DesktopDefault.aspxAccessed January 18, 2009.
  107. American Academy of Hospice and Palliative Medicine Fellowship Directory. http://www.aahpm.org/fellowship/index.htmlAccessed July 25, 2008.

 Supervising editors: Robert J. Zalenski, MD, MA; Michael L. Callaham, MD

 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. Dr. Quest is funded as a co-investigator by the National Cancer Institute (5 R25 CA116472) for work on the EPEC-Emergency Medicine Project.

 Publication date: Available online January 29, 2009.

 Reprints not available from the authors.

PII: S0196-0644(08)02058-1

doi: 10.1016/j.annemergmed.2008.11.019

Annals of Emergency Medicine
Volume 54, Issue 1 , Pages 94-102 , July 2009