Palliative care interventions for adults in the emergency department : a review of components, delivery models, and outcomes

Article indépendant

BAYUO, Jonathan | AGBEKO, Anita Eseenam | ACHEAMPONG, Emmanuel Kwasi | ABU-ODAH, Hammoda | DAVIDS, Jephtah

Background: Existing evidence suggest the emergence of palliative care (PC) services in the Emergency Department (ED). To gain insight into the nature of these services and provide direction to future actions, there is a need for a comprehensive review that ascertains the components of these services, integration models, and outcomes. Methods: A scoping review design was employed and reported according to the PRISMA extension guidelines for scoping reviews. Extensive searches in peer-reviewed databases (CINAHL, EMBASE, PubMed, Cochrane Library, and Medline) and grey literature sources (Trove, MedNar, OpenGrey, and the Agency for Healthcare Research and Quality) were undertaken and supplemented with hand searching. Titles, abstracts, and full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on a PC intervention implemented in the ED for adults. Codes were formulated across the included studies which facilitated the conduct of a narrative synthesis. Results: Twenty-three studies were retained with the majority (n=15) emerging from the United States. The components of PC interventions in the ED were categorized as: 1) screening 2) goals of care discussion and communication 3) managing pain and other distressing symptoms in the ED 4) transitions across care settings 5) end-of-life care 6) family/ caregiver support 7) ED staff education. Traditional PC consultations and integrated ED-PC services were the main modes of delivery. PC in the ED can potentially improve patient symptoms, facilitate access to relevant services, reduce length of stay, improve care at the end of life; facilitate bereavement and post-bereavement support for family members; and improve ED staff confidence in delivering PC. Conclusion: PC implementation in the ED may potentially improve patient and family outcomes. More studies are however needed to standardize trigger or screening tools. More prospective studies are also needed to test PC interventions in the ED.

http://dx.doi.org/10.1111/acem.14508

Voir la revue «Academic emergency medicine, 29»

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