Abstract
BackgroundDue to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas.MethodsA questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services.ResultsIn total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics.ConclusionsThe study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future.
Highlights
Due to the ageing population in Hong Kong, the importance and need of palliative care and end-oflife (EOL) care are coming under the spotlight
Palliative care is defined by the World Health Organization (WHO) as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” [2]
In the Queen Elizabeth Hospital (QEH) Emergency Department (ED), EOL care was provided by a dedicated team of emergency physicians with an inpatient bed inside the Emergency Medicine Ward (EMW) [11, 17] Consultations from other inpatient departments were assessed by the on-duty emergency physicians and required terminally ill patients would be taken over to the EMW for treatment
Summary
Due to the ageing population in Hong Kong, the importance and need of palliative care and end-oflife (EOL) care are coming under the spotlight. An ageing population imposes significant burdens on different aspects of the society at large, on the demands of the health care services. Care for elderly patients with multiple comorbidities and patients with terminal and incurable diseases focuses on improving the quality of life, i.e. palliative and end-of-life (EOL) care, instead of aggressive disease-directed treatments. Palliative care is defined by the World Health Organization (WHO) as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” [2]
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