Abstract
BackgroundMuch effort has been made to explore how patients with advanced chronic illness and their families experience care when they attend the Emergency Department, and many studies have investigated how healthcare professionals perceive Palliative Care provision in the Emergency Department. Various models exist, but nonetheless incorporating palliative care into the Emergency Department remains challenging. Considering both healthcare professionals’ and users’ perspective on problems encountered in delivering and receiving appropriate palliative care within this context may provide important insight into meaningful targets for improvements in quality of care. Accordingly, this study aims at exploring issues in delivering palliative care in the Emergency Department from the perspective of both providers and users, as part of a larger project on the development and implementation of a quality improvement program in Italian Emergency Departments.MethodsA qualitative study involving focus group interviews with Emergency Department professionals and semi-structured interviews with patients with palliative care needs in the Emergency Department and their relatives was conducted. Both datasets were analyzed using Thematic Analysis.ResultsTwenty-one healthcare professionals, 6 patients and 5 relatives participated in this study. Five themes were identified: 1) shared priorities in Emergency Department among healthcare professionals and patients, 2) the information provided by healthcare professionals and that desired by relatives, 3) perception of environment and time, 4) limitations and barriers to the continuity of care, and 5) the contrasting interpretations of giving and receiving palliative care.ConclusionsThis study provides insights into targets for changes in Italian Emergency Departments. Room for improvement relates to training for healthcare professionals on palliative care, the development of a shared care pathway for patients with palliative care needs, and the optimization of Emergency Department environment. These targets will be the basis for the development of a quality improvement program in Italian Emergency Departments.
Highlights
Palliative Care (PC) is defined as the holistic care approach aimed at guaranteeing relief from suffering and improving quality of life for people with life-limiting illness, as well as their families [1]
Two professionals who could not participate in the Focus group (FG) meetings, for not-disclosed reasons, were replaced with their substitutes; five could not be replaced as they did not provide timely notice for researchers to contact substitutes
Patients, the information provided by professionals and that desired by relatives, perceptions of environment and time, limitations and barriers to the continuity of care and the contrasting interpretations of giving and receiving PC
Summary
Palliative Care (PC) is defined as the holistic care approach aimed at guaranteeing relief from suffering and improving quality of life for people with life-limiting illness, as well as their families [1]. Many ED healthcare professionals (HPs) recognize the importance of PC provision in the ED [13,14,15,16], and various model exist on incorporating PC into the ED [17,18,19], some conceive PC to be beyond of their scope or even at odds with the principles of emergency medicine [13, 16, 20,21,22,23,24] This has been documented in two specific surveys [22, 25], whose results evidence that PC is eventually provided to a limited number of patients presenting to the ED, presumably much fewer than those in need.
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