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

Michele Levinson, Katherine J Walker, Jennifer Hanning, William
Dunlop, Edward Cheong & Amber Mills (2019): Medical perspectives regarding goals-of-care consultations in Emergency Departments, Psychology, Health & Medicine, DOI:10.1080/13548506.2019.1595683

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.

Link to full article here.