Palliative care for end-of-life patients in a basic emergency service

The Necessity of Palliative Care Interventions in Emergency Departments: A Literature Review

Palliative care, a beacon of relief and comfort, ensures the best quality of life for patients nearing death, a patient population that often presents to emergency departments, by providing interventions to promote comfort and support final wishes. The purpose of this literature review was to examine the outcomes of palliative care interventions for adult patients with chronic illnesses who have died in emergency departments. The literature review was conducted in CINAHL, PubMed, SCOPUS, OVID, and APA Psych using the keywords "palliative," "emergency department," "adult," and "chronic disease." The search was limited to English language publications with no date limits and performed according to Preferred Reporting Items for Systematic reviews and Meta-Analysis statement standards. The search yielded 531 articles, with 226 duplicates excluded. After a review, only 16 articles met the inclusion criteria. Common interventions included implementing screening tools, enhancing communication skills, providing end-of-life care education, and health record alerts for palliative care criteria. This review highlights how critical palliative care interventions are needed in emergency departments. The inevitability of seriously ill patients presenting to emergency departments underscores the urgency and importance of palliative care interventions, leading to increased comfort and decreasing distressing symptoms experienced by dying patients.

" I can't do it anymore": a qualitative study on the emergence of crisis in outpatient palliative care-the perspective of family caregivers

BACKGROUND

The outpatient palliative care system is a central component of the palliative care structure in Germany, with family caregivers playing a vital role in ensuring and maintaining its success. However, crisis situations can destabilise and harm outpatient care. Previous studies have analysed hospitalisations and emergency admissions during palliative care. However, little is known about the factors that contribute to the emergence of crises in palliative outpatient care. The aim of this study was to identify factors contributing to the emergence of crisis in palliative outpatient care including the identification of protective strategies.

METHODS

A qualitative study using semi-structured interviews with family caregivers recently involved in outpatient palliative care was performed. The analysis was conducted using thematic coding.

RESULTS

A total of 15 family caregivers (13 female and 2 male) were recruited for the study. Crisis situations emerged through a cumulation of factors. Four categories of factors were identified: (1) structural factors, including limited access to health care professionals and a lack of necessary information, (2) illness related factors such as sudden progression in the illness trajectory and symptoms, (3) the intensity of care involvement and (4) emotional and psychological burden of family caregivers. A diverse range of protective strategies were employed by family caregivers, encompassing the involvement of the social network, the pursuit of information and the identification of a sense of purpose.

CONCLUSION

The findings of this study confirm the importance of providing continuous, competent, and empathetic care to both family caregivers and patients in palliative outpatient care. The study highlights the importance of expanding the palliative care infrastructure, as well as ensuring unrestricted access to palliative care professionals, developing tailored information tools for family caregivers, and reducing bureaucracy. Further studies are needed to identify additional influencing factors and evaluate effective measures.

Experiences of emergency department nurses using palliative care resources and associated tools in the provision of quality care of a dying patient

Access to quality palliative and end-of-life care in the emergency department is as vitally important as care at any other stage of life. This study aimed to investigate nurses' perceptions of the use of a suite of dedicated resources to support the provision of care to patients who are dying in the emergency environment. The study followed a qualitative descriptive design; 11 semi-structured interviews were conducted and analysed using thematic coding. Five themes were developed: facilitating care delivery; comfort and environmental adjustments; visual symbolism; developing knowledge to overcome fear; and perceptions of family experiences. There is an increasing need to access palliative care in the emergency department; the use of a suite of resources can play an important role in the provision of quality care to the dying.

The conscious state of the dying patient: An integrative review

OBJECTIVES

The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs.

METHODS

An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach.

RESULTS

Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying.

SIGNIFICANCE OF RESULTS

In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

Background and objectives: Palliative care (PC) prevents and alleviates patients´ suffering to improve their quality of life in their last days. In recent years, there has been an increase in visits to the emergency services (ES) by patients who may need this type of care. The aims were to describe the training and capacitation of nurses from ES in PC. Accordingly, a systematic review was performed. Materials and Methods: Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used. The search equation was “Palliative care and nursing care and emergency room”. A total of 12 studies were selected. Results: The studies agree on the need for training professionals in PC to provide a higher quality care, better identification of patient needs and to avoid unnecessary invasive processes. Similarly, the implementation of a collaborative model between ES and PC, the existence of a PC specialized team in the ES or proper palliative care at home correspond to a decrease in emergency visits, a lower number of hospitalizations or days admitted, and a decrease in hospital deaths. Conclusions: The development of PC in the different areas of patient care is necessary. Better palliative care leads to a lower frequency of ES by terminal patients, which has a positive impact on their quality of life. Access to PC from the emergency unit should be one of the priority health objectives due to increment in the aged population susceptible to this type of care.

Healthcare Received in the Last Months of Life in Portugal: A Systematic Review

Background: While evidence demonstrates that end-of-life care practices vary across countries, there is still a lack of evidence regarding the healthcare that is received by adult individuals in the last months of life in Portugal. Methods: This is a systematic review that aims to examine the evidence published until 2019 regarding the healthcare received by adult individuals in the last months of life in Portugal. Results: Nine studies were included in this review. All of these were quantitative and retrospective studies, used patient records as the source of information, and were conducted in hospital settings. The time frame analysis before death ranged from 48 h to 3 months. The majority of the studies focused on the physical aspects of care, such as physical needs assessment and symptom management, prescribed medication, and invasive interventions. No evidence was found regarding spiritual, psychological, social or cultural needs. Conclusion: Although using patient records as a source of information may introduce a bias, this study indicates that there is a greater emphasis on the physical aspects of care and less on the psychological, spiritual or social aspects of care received by adult individuals in their last months of life in Portugal.