Medical perspectives regarding goals-of-care consultations in Emergency Departments

Michele Levinson, Katherine J. Walker, Jennifer Hanning, William Dunlop, Edward Cheong, Amber Mills

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Goals-of-care discussions aim to establish patient values for shared medical decision-making. These discussions are relevant towards end-of-life as patients may receive non-beneficial treatments if they have never discussed preferences for care. End-of-life care is provided in Emergency Departments (EDs) but little is known regarding ED-led goals-of-care discussions. We aimed to explore practitioner perspectives on goals-of-care discussions for adult ED patients nearing end-of-life. We report the qualitative component of a mixed methods study regarding a ‘Goals-of-Care’ form in an Australian ED. Eighteen out of 34 doctors who completed the form were interviewed. We characterised ED-led goals-of-care consultations for the first time. Emergency doctors perceive goals-of-care discussions to be relevant to their practice and occurring frequently. They aim to ensure appropriate care is provided prior to review by the admitting team, focusing on limitations of treatment and clarity in the care process. ED doctors felt they could recognise end-of-life and that ED visits often prompt consideration of end-of-life care planning. They wanted long-term practitioners to initiate discussions prior to patient deterioration. There were numerous interpretations of palliative care concepts. Standardisation of language, education, collaboration and further research is required to ensure Emergency practitioners are equipped to facilitate these challenging conversations.

Original languageEnglish
Pages (from-to)1137-1147
Number of pages11
JournalPsychology, Health and Medicine
Volume24
Issue number9
DOIs
Publication statusPublished - 21 Oct 2019

Keywords

  • Communication
  • emergency medicine
  • medical futility
  • resuscitation orders
  • withholding treatment

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