Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA.
J Pain Symptom Manage. 2012 Jan;43(1):1-9. doi: 10.1016/j.jpainsymman.2011.03.022. Epub 2011 Jul 30.
Palliative care focuses on the relief of pain and suffering and achieving the best possible quality of life for patients. Although traditionally delivered in the inpatient setting, emergency departments (EDs) are a new focus for palliative care consultation teams.
To explore attitudes and beliefs among emergency care providers regarding the provision of palliative care services in the ED.
Three semistructured focus groups were conducted with attending emergency physicians from an academic medical center, a public hospital center, and a community hospital. The discussions were digitally recorded and transcribed to conduct a thematic analysis using grounded theory. A coding scheme was iteratively developed to subsequently identify themes and subthemes that emerged from the interviews.
Twenty emergency physicians participated (mean age 41 years, range 31-61 years, median practice time nine years, 40% female). Providers acknowledged many benefits of palliative care presence in the ED, including provision of a specialized skill set, time to discuss goals of care, and an opportunity to intervene for seriously ill or injured patients. Providers believed that concerns about medicolegal issues impaired their ability to forgo treatments where risks outweigh benefits. Additionally, the culture of emergency medicine-to provide stabilization of acute medical emergencies-was sometimes at odds with the culture of palliative care, which balances quality of life with the burdens of invasive treatments. Some providers also felt it was the primary physician's responsibility, and not their own, to address goals of care. Finally, some providers expressed concern that palliative care consultation was only available on weekdays during daytime hours. Automatic consultation based on predetermined criteria was suggested as a way to avoid conflicts with patients and family.
Emergency providers identified many benefits to palliative care consultation. Solving logistical problems and developing clear indications for consultation might help increase the use of such services.
姑息治疗专注于缓解疼痛和痛苦，为患者实现尽可能好的生活质量。尽管姑息治疗传统上是在住院环境中提供的，但急诊科（ED）是姑息治疗咨询团队的新关注点。
探讨急诊医护人员对在急诊科提供姑息治疗服务的态度和信念。
在一家学术医疗中心、一家公立医院中心和一家社区医院，对主治急诊医师进行了三次半结构化焦点小组讨论。讨论内容被数字化记录并转录，以便使用扎根理论进行主题分析。制定了一个编码方案，以迭代方式确定从访谈中出现的主题和子主题。
20 名急诊医师参加了研究（平均年龄 41 岁，范围 31-61 岁，中位从业时间为 9 年，40%为女性）。提供者承认姑息治疗在急诊科的存在有许多好处，包括提供专门的技能集、有时间讨论护理目标以及为重病或受伤的患者提供干预的机会。提供者认为，对医疗法律问题的担忧会影响他们放弃风险大于收益的治疗的能力。此外，急诊医学的文化——提供急性医疗紧急情况的稳定——有时与姑息治疗的文化相冲突，后者平衡生活质量与侵入性治疗的负担。一些提供者还认为，解决护理目标是主治医生的责任，而不是他们自己的责任。最后，一些提供者表示担心姑息治疗咨询仅在工作日白天提供。根据预定标准自动咨询被认为是避免与患者和家属发生冲突的一种方式。
急诊医护人员确定了姑息治疗咨询的许多好处。解决后勤问题并明确咨询指征可能有助于增加此类服务的使用。
