Abstract
Introduction The aim of our study was to investigate challenges faced by emergency physicians (EPs) who provide prehospital emergency care to patients with advanced incurable diseases and family caregivers in their familiar home environment. Methods Qualitative study using semistructured interviews with open-ended questions to collect data from 24 EPs. Data were analyzed using qualitative content analysis. Results We identified nine categories of challenges: structural conditions of prehospital emergency care, medical documentation and orders, finding optimal patient-centered therapy, uncertainty about legal consequences, challenges at the individual (EP) level, challenges at the emergency team level, family caregiver's emotions, coping and understanding of patient's illness, patient's wishes, coping and understanding of patient's illness, and social, cultural, and religious background of patients and families. EPs strengthened that the integrations of specialized prehospital palliative care services improved emergency care by providing resources to patients and family caregivers, enhancing the quality and availability of medical documentation and accessibility of aftercare in emergencies. Areas of improvement that were identified were to promote emergency physicians' knowledge and skills in palliative care, communication, and family caregiver support by education and training. Furthermore, structures for better care on-site, thorough medical documentation, and specialized palliative care emergency facilities in hospital and prehospital care were requested. Conclusion Prehospital emergency care in patients with advanced incurable diseases in their familiar home environment may be improved by training EPs in palliative care, communication, and caregiver support competences. Results underline the importance of collaborative specialized palliative care and prehospital emergency care.
Highlights
Palliative care intends to improve the quality of life of patients suffering from advanced incurable, life-limiting diseases and by enabling them to live a dignified life until patients’ death in the desired environment
Previous studies have shown that the number of prehospital emergency care visits ranges from 2–10% in patients with advanced incurable diseases in their familiar home environment [3,4,5,6]. erefore, every prehospital provider can be confronted with patients at an advanced stage of disease who need emergency medical care [6]. e majority of prehospital emergency calls and emergency department
Since general prehospital palliative care was not defined by specific care structures in Germany at that time, the term “patients with advanced incurable disease in their familiar home environment” was left partly undefined intentionally to include challenges caused by missing definitions and structures in this context
Summary
Palliative care intends to improve the quality of life of patients suffering from advanced incurable, life-limiting diseases and by enabling them to live a dignified life until patients’ death in the desired environment. Patients with advanced incurable diseases and family caregivers can face diverse sudden and sometimes acute life-threatening problems in their familiar home environment, such as dyspnea, convulsive attacks, pain exacerbation, or severe anxiety, which may lead to emergency calls and subsequent hospital admissions [2]. Emergency Medicine International visits of patients with advanced incurable diseases are caused by shortness of breath, pain, neurological disorders, family caregiver exhaustion [7,8,9], by disease-related anxiety, or feelings of safety and familiarity with the hospital setting [9, 10] and are dependent upon local community-based healthcare structures and population areas [11].
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