Review article: Goals-of-care discussions for adult patients nearing end-of-life in emergency departments: A systematic review

Introduction: Goals-of-care discussions at end-of-life are associated with increased patient satisfaction and reduced treatment burdens, reduced family and healthcare worker distress and healthcare costs, while achieving equal life-expectancy. It is unclear how goals-of-care discussions should occur Emergency Departments.

Objectives: To determine which patients could benefit, requirements, content, documentation, and harms and benefits of Emergency medicine goals-of-care discussions.

Methods: We sought primary evidence on goals-of-care discussions in Emergency Departments with adult patients nearing end-of-life, published in English after 1989. Data sources included Medline, Embase, PsycINFO, CINAHL, Web of Science, and reference lists of included articles.

Results: 1920 abstracts were screened, 5 articles selected. There was no consensus on the meaning of goals-of-care, which is often confused with advanced care planning and treatment limitation. Emergency clinicians can identify most patients needing discussions following training. There was no evidence for how to involve stakeholders, nor how to adapt conversations to meet Cultural and Linguistically Diverse needs. Expert panels have suggested requirements and content for conversations with little supporting evidence. There was no evidence for how emergency conversations differ to those in other settings, nor for harms or benefits for holding Goals-of-Care conversations in emergency departments. Increased ED Goals-of-Care conversations increased hospice referral and reduced in-patient admissions.
Limitations: Most studies were of moderate quality only, outcomes were not standardised, and sample sizes were small. “Goals-of-care” is used inconsistently across the literature.

Conclusion: This is the first systematic review regarding goals-of-care discussions in Emergency Departments. Further research is needed on all aspects of these conversations.